离心泵对小儿体外循环血小板功能影响.docVIP

离心泵对小儿体外循环血小板功能影响 　 作者：周成斌 ，张镜芳，章晓华，陈萍，庄建，陈欣欣 【关键词】 血小板功能 摘要：目的 探讨离心泵对小儿体外循环（CPB）血小板功能的影响。方法 20例复杂先天性心脏病患儿随机分为离心泵组（n=10）和滚轴泵组（n=10）。离心泵组采用离心泵（Biopump BP50泵头），滚轴泵组使用StockertⅢ心肺机(滚轴泵)，常规建立CPB，行心脏畸形根治术。分别于麻醉前（T1）、CPB结束即刻（T2）、CPB结束后24h（T3）取静脉血测定血小板计数、血小板颗粒膜蛋白-140（GMP-140）、血栓素B2（TXB2）和6-酮体-前列腺素F1α（6-keto-PGF1α）。结果 两组患儿CPB时间、阻断时间、最低鼻咽温度无显著性差异。T2期两组患儿血小板数量下降（P＜0.05），组间无显著性差异。T2期两组患儿GMP-140增高（P＜0.05），滚轴泵组增高更为显著（P＜0.05）；滚轴泵组TXB2、6-keto-PGF1α水平超过离心泵组（P＜0.05）。术后24h内离心泵组胸液量明显少于滚轴泵［离心泵组(6.4±4.1)ml/kg 比滚轴泵组(11.1±3.3)ml/kg，P＜0.05］。两组患儿用血量和ICU时间没有显著差异。结论 离心泵较滚轴泵明显减少对血小板的破坏，但是临床结果没有明显优势。 　　关键词：离心泵；小儿；体外循环；血小板功能 　　Effect of Centrifugal Pump on Blood Platelet Functions during Cardiopulmonary Bypass in Children 　　Abstract: OBJECTIVE To evaluate the effect of centrifugal pump on blood platelet functions during cardiopulmonary bypass(CPB) in children. METHODS Twenty children with complex congenital heart diseases scheduled for open-heart surgery with CPB were randomized to be perfused with either a centrifugal pump (n=10) or a roller pump (n=10). Blood samples were obtained for determination of platelet count, platelet guanosine monophosphate-140(GMP-140), thromboxane B2 (TXB2) and 6-keto-prostaglandin F1α （6-keto-PGF1α）before anesthesia, at the end of CPB and 24 hr after CPB. RESULTS There were no significant differences in preoperative or intraoperative parameters, including CPB time, cross-clamping time and minimum nasopharyngeal temperature. The reduction in platelet count at T2 in both groups were similar. In both groups platelet GMP-140 levels were significantly increased at T2, with the roller pump group being more elevated when compared with the centrifugal pump group (P＜0.05). The increase of TXB2 and 6-keto-PGF1α levels was greater in the roller pump group at T2 (P＜0.05). Chest drainage in the centrifugal pump group was remarkably lower than that of the roller pump group (P＜0.05). There were no difference between the two groups in blood product requirements and duration of int