急性血小板分离回输对体外循环下心内直视手术患者血小板活化功能的影响  

Effect of acute plateletpheresis and back-transfusion on platelet activation in patients undergoing open heart surgery with CPB

作　　者：魏海燕[1] 丁正年 史宏伟[1] 葛亚力[1] 张媛[1] 陈鑫[2] 

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)麻醉科,210006 [2]南京医科大学附属南京医院(南京市第一医院)胸心外科,210006 [3]本大学第一附属医院麻醉科

出　　处：《中华麻醉学杂志》2015年第3期274-278,共5页Chinese Journal of Anesthesiology

基　　金：基金项目：南京市卫生局医学科技发展项目（YKK06066）

摘　　要：目的评价急性血小板（Ph）分离回输对体外循环（CPB）下心内直视手术患者血小板活化功能的影响。方法择期CPB下心脏瓣膜置换术患者40例，年龄35—64岁，BMI在正常范围，NYHA分级Ⅱ或Ⅲ级，ASA分级Ⅱ或Ⅲ级，采用随机数字表法分为2组（n=20）：对照组（c组）和急性Plt分离回输组（APP组）。APP组在麻醉诱导后进行Pit分离回输，上一轮分离循环结束时立即回输浓缩红细胞和贫血小板血浆，同时进入下一轮分离循环，提取富Pit血浆（PRP）保存，并于鱼精蛋白中和肝素后回输。于麻醉诱导前（基础状态）、Pit分离结束后肝素化前、鱼精蛋白中和肝素后PRP回输前、术毕和术后24h时采集静脉血样，测定Pit激活前和激活后CD62p和PAC-1的表达水平，并于Pit分离结束后、PRP回输前检测APP组全血和PRP中Pit激活前和激活后CD62p和PAC-1的表达水平。结果与c组比较，APP组术毕时Ph激活前CD62p和PAC-1表达下调，Pit激活后CD62p和PAC-1表达上调（P〈0．05或0．01）；与全血比较，PRP中Plt激活前CD62p和PAC-1表达下调，Plt激活后CD62p和PAC-1表达上调（P〈0．01）。结论急性Pit分离不引起CPB下心内直视手术患者Plt活化，而Ph回输可增强体内Plt活化功能。Objective To evaluate the effect of acute plateletpheresis （APP） and back-transfusion on platelet activation in the patients undergoing open heart surgery with cardiopulmonary bypass （ CPB）. Methods Forty patients, aged 35-64 yr, with body mass index within the normal range, of ASA physical status It or m （NYHA Ⅱ or Ⅲ ）, scheduled for elective cardiac valve replacement under CPB, were randomly divided into 2 groups （ n = 20 each） using a random number table ： control group （ group C） and APP group. In group APP, after induction of anesthesia, APP was performed, packed red blood ceils and platelet-poor plasma were transfused back to the patient after termination of the previous cycle, and another cycle was started simultaneously. Platelet-rich plasma （PRP） was harvested and transfused back to the pa- tient after termination of CPB and neutralization of heparin with protamine. Before induction of anesthesia （baseline） , after APP and before heparinization, after neutralization of heparin with protamine and before back-transfusion of PRP, at the end of operation, and at 24 h after operation, venous blood samples were collected for determination of the expression of CD62p and PAC-1 in inactivated platelets and activated platelets by adenosine diphosphate （ADP）. After APP and before heparinization, and after neutralization of heparin with protamine and before back-transfusion of PRP, the expression of CD62p and PAC-1 in inac- tivated platelets and ADP-activated platelets was detected in the whole blood and PRP in group APP. Re- suits Compared with C group, the expression of CD62p and PAC-1 in inactivated platelets was down-regu- lated at the end of operation, and the expression of CD62p and PAC-1 in ADP-activated platclets was up- regulated in APP group. The expression of CD62p and PAC-1 in inactivated platelets was down-regulated in PRP, and the expression of CD62p and PAC-1 in ADP-activated platelets was up-regulated in PRP as com- pared with those in the whole blood. Conclusion

关 键 词：血小板去除法 血小板活化 心肺转流术 心脏外科手术 

分 类 号：R614[医药卫生—麻醉学]