体外循环中肝素涂层管道对凝血系统的影响

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1、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(Extracorporealcirculation,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、ECC60min、肝素中和后30min、60min及术后1d测定血小板计数(PLC)、AT-Ⅲ、GMP-140的浓度及术后1d出血量。利用电子显微镜观察两组转流后微

2、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(P<0.05)；血浆GMP-140浓度在ECC60min、中和后30min、60min显著高于HCC组，有极显著性差异(P<0.001)，术后1d的浓度有显著性差异(P<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

3、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　　TheEffectsofHeparin-CoatedCircuitontheSystemicCoagulationDuringExtracorporealCirculation9　　Abstract:OBJECTIVEToevaluatetheeffectsofheparin-coatedcircuit(HCC)ontheplateletcount(PLC)andtheconcentrationofGMP-140andAT-Ⅲdurin

4、gextracorporealcirculation(ECC).METHODSTwenty-threepatientsprostheticvalvereplacementwererandomlydividedintotwogroups:theheparin-coatedcircuitgroup(HCC,n=8),theuncoatedcircuitgroup(UCC,n=15)．RESULTSThemeanbloodlossofpatientsintheUCCwashigherthanthatintheHCC(P&

5、lt;0.05)atthefirstdaypost-operative(PO1d).Atboth60minutesECC，30minutespostprotamineneutralizationandPO1dthePLCintheHCCwashigherthanthatintheUCC(P<0.05).Atboth60minutesECCand30minutespostprotamineneutralizationtheGMP-140intheUCCwashigherthanthatintheHCC(P<

6、;0.001)，andatPO1dtheGMP-140intheUCCwashigherthanthatintheHCC(P<0.05).TherewasnodifferenceintheconcentrationofAT-IIIinbothgroups.ElectronmicroscopyshowsthatintheHCC,thearterialfiltermeshedgesandfringesweredistinct.Occasionally,fragmentsandflocculescouldbesee

7、n.However,thefragmentsandflocculesintheUCCwerescatteredfrequently,causingblurringoftheedgesofthefiltermeshandevenblockageofthefiltermesh.CONCLUSIONThisstudysuggestedthatusingHCCinECCissafeandprotectssystemiccoagulation.HCChasagood9biocompatibility.　　Keywords：E

8、xtracorporealcirculation；Heparin-coatedcircuit；Coagulation　　1资料与方法　　1.1临床资料　　选取23例患者，术前无神经系统、肝、肾等疾病，患者未服用华法令，未接受肝素抗凝治疗，五天内未服用抗血小板药物,术前一周未曾服用阿司匹林等影响血小板的药物，术前出、凝血指标均在正常范围，预计体外循环（Extr