CAJ | 학술논문

目的评价急性血小板(Plt)分离回输对体外循环(CPB)下心内直视手术患者血小板活化功能的影响.方法择期CPB下心脏瓣膜置换术患者40例,年龄35 ～ 64岁,BMI在正常范围,NYHA分级Ⅱ或Ⅲ级,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=20):对照组(C组)和急性Plt分离回输组(APP组).APP组在麻醉诱导后进行Plt分离回输,上一轮分离循环结束时立即回输浓缩红细胞和贫血小板血浆,同时进入下一轮分离循环,提取富Plt血浆(PRP)保存,并于鱼精蛋白中和肝素后回输.于麻醉诱导前(基础状态)、Plt分离结束后肝素化前、鱼精蛋白中和肝素后PRP回输前、术毕和术后24 h时采集静脉血样,测定Plt激活前和激活后CD62p和PAC-1的表达水平,并于Plt分离结束后、PRP回输前检测APP组全血和PRP中Plt激活前和激活后CD62p和PAC-1的表达水平.结果与C组比较,APP组术毕时Plt激活前CD62p和PAC-1表达下调,Plt激活后CD62p和PAC-1表达上调(P＜0.05或0.01);与全血比较,PRP中Plt激活前CD62p和PAC-1表达下调,Plt激活后CD62p和PAC-1表达上调(P＜0.01).结论急性Plt分离不引起CPB下心内直视手术患者Plt活化,而Plt回输可增强体内Plt活化功能.
목적 평개급성혈소판(Plt)분리회수대체외순배(CPB)하심내직시수술환자혈소판활화공능적영향.방법 택기CPB하심장판막치환술환자40례,년령35 ～ 64세,BMI재정상범위,NYHA분급Ⅱ혹Ⅲ급,ASA분급Ⅱ혹Ⅲ급,채용수궤수자표법분위2조(n=20):대조조(C조)화급성Plt분리회수조(APP조).APP조재마취유도후진행Plt분리회수,상일륜분리순배결속시립즉회수농축홍세포화빈혈소판혈장,동시진입하일륜분리순배,제취부Plt혈장(PRP)보존,병우어정단백중화간소후회수.우마취유도전(기출상태)、Plt분리결속후간소화전、어정단백중화간소후PRP회수전、술필화술후24 h시채집정맥혈양,측정Plt격활전화격활후CD62p화PAC-1적표체수평,병우Plt분리결속후、PRP회수전검측APP조전혈화PRP중Plt격활전화격활후CD62p화PAC-1적표체수평.결과 여C조비교,APP조술필시Plt격활전CD62p화PAC-1표체하조,Plt격활후CD62p화PAC-1표체상조(P＜0.05혹0.01);여전혈비교,PRP중Plt격활전CD62p화PAC-1표체하조,Plt격활후CD62p화PAC-1표체상조(P＜0.01).결론 급성Plt분리불인기CPB하심내직시수술환자Plt활화,이Plt회수가증강체내Plt활화공능.
Objective To evaluate the effect of acute plateletpheresis (APP) and back-transfusion on platelet activation in the patients undergoing open heart surgery with cardiopulmonary bypass (CPB).Methods Forty patients,aged 35-64 yr,with body mass index within the normal range,of ASA physical status Ⅱ or Ⅲ (NYHA Ⅱ or Ⅲ),scheduled for elective cardiac valve replacement under CPB,were randomly divided into 2 groups (n =20 each) using a random number table:control group (group C) and APP group.In group APP,after induction of anesthesia,APP was performed,packed red blood cells and platelet-poor plasma were transfused back to the patient after termination of the previous cycle,and another cycle was started simultaneously.Platelet-rich plasma (PRP) was harvested and transfused back to the patient after termination of CPB and neutralization of heparin with protamine.Before induction of anesthesia (baseline),after APP and before heparinization,after neutralization of heparin with protamine and before back-transfusion of PRP,at the end of operation,and at 24 h after operation,venous blood samples were collected for determination of the expression of CD62p and PAC-1 in inactivated platelets and activated platelets by adenosine diphosphate (ADP).After APP and before heparinization,and after neutralization of heparin with protamine and before back-transfusion of PRP,the expression of CD62p and PAC-1 in inactivated platelets and ADP-activated platelets was detected in the whole blood and PRP in group APP.Results Compared with C group,the expression of CD62p and PAC-1 in inactivated platelets was down-regulated at the end of operation,and the expression of CD62p and PAC-1 in ADP-activated platelets was upregulated in APP group.The expression of CD62p and PAC-1 in inactivated platelets was down-regulated in PRP,and the expression of CD62p and PAC-1 in ADP-activated platelets was up-regulated in PRP as compared with those in the whole blood.Conclusion APP can not induce platelet activation,however,platelet back-transfusion can enhance platelet activation in the patients undergoing open heart surgery with CPB.