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ID:15201666
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页数:9页
时间:2018-08-02
《体外循环中肝素涂层管道对凝血系统的影响》由会员上传分享,免费在线阅读,更多相关内容在学术论文-天天文库。
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
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