体外循环中肝素涂层管道对凝血系统的影响

体外循环中肝素涂层管道对凝血系统的影响【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)和对比组(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。结果对比组 PLC 在转流中、术后 1d 显着低于 HCC 组,差异有显着性()；血浆 GMP-140 浓度在 ECC 60 min、中和后 30 min、60 min 显着高于 HCC 组，有极显着性差异()，术后 1 d 的浓度有显着性差异()；两组 AT-Ⅲ 值无显着性差异；HCC 组动脉过滤网表面光洁，网眼边缘清楚，偶见白细胞和血小板附着；对比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 () 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 (). At both 60 minutes ECC and 30 minutes post protamine neutralization the GMP-140 in the UCC was higher than that in the HCC ()， and at PO 1d the GMP-...