离心泵在体外循环中对凝血功能的影响  

Effect of Centrifugal Pump on Coagulation Function During Cardiopulmonary Bypass

作　　者：孟凡伟[1] 李建朝[1] 钱晓亮[1] 谢周良[1] 赵子牛[1] 葛振伟[1] 姚东风[1] 任培军 杨雷一[1] 程兆云[1] MENG Fanwei;LI Jianchao;QIAN Xiaoliang;XIE Zhouliang;ZHAO Ziniu;GE Zhenwei;YAO Dongfeng;REN Peijun;YANG Leiyi;CHENG Zhaoyun(Department of Cardiopulmonary Bypass,Heart Center of Henan Province People’s Hospital/Fuwai Central China Cardiovascular Hospital/Fuwai Central China Hospital of Zhengzhou University,Zhengzhou 450046,China)

机构地区：[1]河南省人民医院心脏中心/阜外华中心血管病医院/郑州大学华中阜外医院体外循环科,河南郑州450046

出　　处：《河南医学研究》2021年第24期4417-4420,共4页Henan Medical Research

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190765)。

摘　　要：目的通过血栓弹力图(TEG)评估滚压泵与离心泵对体外循环患者凝血功能的影响。方法从2020年1月至2021年2月于阜外华中心血管病医院心外瓣膜病手术中入选体外循环手术患者30例,按随机数字表法分为离心泵组和滚压泵组。两组仅有体外循环主泵不同。在全身麻醉后、体外循环结束鱼精蛋白中和30 min后抽颈内静脉血,做血栓弹力图,包括激活全血凝固时间(ACT)、凝血反应时间(R),凝血时间(K),血凝块形成速率α角,血凝块最大强度(MA),比较两组的凝血功能。同时观察两组术后用血量、术后24 h引流量、呼吸机时间、ICU停留时间。结果两组术后结果ACT、K值、α角、MA比较,差异无统计学意义(P>0.05)。两组术后血小板计数、纤维蛋白原、呼吸机时间、ICU停留时间、冷沉淀用量、血浆用量、24 h引流量比较,差异无统计学意义(P>0.05)。术后两组异常TEG发生率差异有统计学意义(P<0.05)。滚压泵组术后异常TEG 9例,发生率为60.00%;纤维蛋白原功能低下7例,发生率为46.67%;凝血因子缺乏6例,发生率为40.00%。结论与滚压泵比较,离心泵可以降低体外循环术后凝血功能障碍的发生率,可能跟离心泵减少了凝血因子和纤维蛋白原的激活有关;但是对于患者术后用血量、术后24 h胸腔引流量、呼吸机时间、ICU停留时间,离心泵并没有显示出明显优势。Objective To evaluate the effect of centrifugal pump on coagulation function in patients with cardiopulmonary bypass by thromboelastography(TEG).Methods A total of 30 patients who underwent cardiopulmonary bypass surgery were selected from January 2020 to February 2021 in Fuwai Central China Cardiovascular Hospital.They were randomly divided into centrifugal pump group and rolling pump group.Only the main pump of cardiopulmonary bypass was different between the two groups.Internal jugular vein blood was drawn after general anesthesia,protamine neutralization after cardiopulmonary bypass and after 30 minutes to do thrombelastography,including activated clotting time of whole blood(ACT),coagulation response time(R),coagulation time(K),blood clot formation rateαangle,maximum amplitude(MA),and compared the coagulation functions in the two groups.At the same time,the postoperative blood volume,postoperative 24 h drainage volume,ventilator time and ICU stay time of the two groups were observed.Results There were no significant differences in ACT,K value,αangle and MA between the two groups(P>0.05).There were no significant differences in platelet count,fibrinogen,ventilator time,ICU stay time,cryoprecipitate dosage,plasma dosage and 24 h drainage between the two groups(P>0.05).The incidence of abnormal TEG in the two groups was statistically significant(P<0.05).In the rolling pump group,there were 9 cases of abnormal TEG(60.00%),7 cases of fibrinogen dysfunction(46.67%)and 6 cases of coagulation factor deficiency(40.00%).Conclusion Compared with rolling pump,centrifugal pump can reduce the incidence of coagulation dysfunction after cardiopulmonary bypass,which may be related to the reduction of the activation of coagulation factors and fibrinogen.However,centrifugal pump does not show obvious advantages in terms of postoperative blood consumption,postoperative 24 h thoracic drainage,ventilator time and ICU stay time.

关 键 词：离心泵 血栓弹力图 体外循环 

分 类 号：R654.1[医药卫生—外科学]