绵羊体外膜氧合期间血小板数量及功能的观察研究  

Platelet count and function during extracorporeal membrane oxygenation in sheep model

作　　者：闫姝洁 王添隆 王靖 张寒 楼松 滕媛 王建 刘刚 吉冰洋 Yan Shujie;Wang Tianlong;Wang Jing;Zhang Han;Lou Song;Teng Yuan;Wang Jian;Liu Gang;Ji Bingyang(Department of Cardiopulmonary Bypass,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]中国医学科学院阜外医院体外循环中心,北京100037

出　　处：《中国体外循环杂志》2025年第1期81-86,共6页Chinese Journal of Extracorporeal Circulation

基　　金：阜外医院青年基金(2022-FWQN03)。

摘　　要：目的在长时间清醒绵羊静脉-静脉体外膜氧合(V-V ECMO)和静脉-动脉体外膜氧合(V-A ECMO)模型上探索ECMO对血小板数量和功能的影响。方法研究纳入10只成年雄性健康小尾寒羊,5只经右颈静脉双腔插管建立V-V ECMO,5只经右颈静脉-右颈总动脉插管建立V-A ECMO,运行168 h后撤除ECMO。在ECMO运行前、运行中不同时间点检测全血血小板数量、二磷酸腺苷诱导的血小板最大聚集率(ADP-PAG)、花生四烯酸诱导的血小板最大聚集率(AA-PAG)和血栓弹力图最大振幅(TEG-MA)。采用重复测量方差分析法比较不同时间点和ECMO模式血小板数量、功能指标的差异。结果10只实验羊均存活至7 d后ECMO撤机。时间因素对血小板数量(P=0.015)和TEG-MA(P=0.025)的主效应有统计学意义。ECMO 24 h的血小板数量和TEG-MA均低于0 h,并在后期逐渐升高,96 h恢复至0 h水平。时间因素对ADP-PAG(P=0.318)和AA-PAG(P=0.157)的主效应皆没有统计学意义。ECMO模式因素对以上血小板数量和功能指标的主效应均无统计学意义(P值分别为0.246、0.093、0.990、0.347)。结论ECMO会在24 h内引起绵羊血小板数量减少、明显减弱血凝块的最大强度,在ECMO支持96 h绵羊血小板数量恢复、血凝块最大强度恢复。Objective This study aimed to investigate the effects of extracorporeal membrane oxygenation(ECMO)on platelet count and function in a sheep model of long-term awake veno-venous(V-V)ECMO and veno-arterial(V-A)ECMO.Methods Ten adult male small-tailed Han sheep were included in this study.Five were cannulated with dual-lumen catheters in the right jugular vein for V-V ECMO,and the other five were cannulated via the right jugular vein and right common carotid artery for V-A ECMO.After running ECMO for 168 hours,it was withdrawn.Platelet counts,ADP-induced platelet aggregation(ADP-PAG),arachidonic acid-induced platelet aggregation rate(AA-PAG),and thromboelastography maximum amplitude(TEG-MA)were tested before and during ECMO at different time points.A repeated measures ANOVA was used to compare the differences in platelet counts,functional parameters at different time points and ECMO modes.Results All 10 experimental sheep survived 7 days on ECMO.The main effects of time and ECMO mode on platelet counts(P=0.015)and TEG-MA(P=0.025)were statistically significant.The platelet count and TEG-MA were lower at 24 hours than those at 0 hours,and gradually increased later on.The main effects of time on ADP-PAG(P=0.318)and AA-PAG(P=0.157)were not statistically significant.The main effects of different ECMO mode on all platelet counts and functional indicators were not statistically significant(P values were 0.246,0.093,0.347).Conclusion ECMO caused a reduction in platelet counts and a marked decrease in the clot firmness within 24 hours,and recovered after 96 hours of ECMO support.

关 键 词：体外膜氧合 绵羊 血小板数量 血小板功能 

分 类 号：R654.1[医药卫生—外科学] R-332[医药卫生—临床医学]