体外循环中肝素涂层管道对凝血系统影响.docVIP

体外循环中肝素涂层管道对凝血系统影响 　【摘要】 目的探讨常规剂量肝素体外循环(Extracorporeal circulation,ECC)下使用肝素涂层管道(HCC) 对血小板计数(PLC)、抗凝血酶Ⅲ(AT-Ⅲ)和血浆α颗粒膜蛋白-140(GMP-140)的影响。 方法机械瓣膜置换术患者随机分为HCC组(n=8)和对照组(UCC，n=15)。分别在ECC前、ECC 60 min、肝素中和后30 min、60min及术后1 d测定血小板计数(PLC)、AT-Ⅲ、GMP-140的浓度及术后 1 d出血量。利用电子显微镜观察两组转流后微栓过滤网上沉积物的附着情况。结果对照组PLC在转流中、术后1d显著低于HCC组,差异有显著性(Plt;0.05)；血浆GMP-140浓度在ECC 60 min、中和后30 min、60 min显著高于HCC组，有极显著性差异(Plt;0.001)，术后 1 d的浓度有显著性差异(Plt;0.05)；两组AT-Ⅲ值无显著性差异；HCC组动脉过滤网表面光洁，网眼边缘清晰，偶见白细胞和血小板附着；对照组动脉过滤网表面可见纤维蛋白沉积，网眼边缘模糊，有大量白细胞及少数活化血小板粘附。结论HCC在ECC中对血小板具有保护作用，较好地改善ECC装置的血液相容性。 【关键词】 体外循环；肝素涂层体外循环管道；凝血 　　The Effects of Heparin-Coated Circuit on the Systemic Coagulation During Extracorporeal Circulation 　　Abstract: OBJECTIVETo evaluate the effects of heparin-coated circuit (HCC) on the platelet count (PLC) and the concentration of GMP-140 and AT-Ⅲ during extracorporeal circulation (ECC). METHODSTwenty-three patients prosthetic valve replacement were randomly divided into two groups: the heparin-coated circuit group (HCC, n=8), the uncoated circuit group (UCC,n=15)． RESULTSThe mean blood loss of patients in the UCC was higher than that in the HCC (Plt;0.05) at the first day post-operative (PO 1d). At both 60 minutes ECC，30 minutes post protamine neutralization and PO 1d the PLC in the HCC was higher than that in the UCC (Plt;0.05). At both 60 minutes ECC and 30 minutes post protamine neutralization the GMP-140 in the UCC was higher than that in the HCC (Plt;0.001)， and at PO 1d the GMP-140 in the UCC was higher than that in the HCC (Plt;0.05). There was no difference in the concentration of AT-III in both groups. Electron microscopy shows that in the HCC, the arterial filter mesh edges and fringes were distinct. Occasionally, fragments and floccules could be seen. However, the fragments and floccules in the UCC were scattered frequently, causing blurring of the edges of the filter mesh and even blockage of the filter mesh. CONCLUSIONThis study suggested that using HCC in ECC is safe and protects syste