血凝酶对体外循环心内直视术患者血小板膜糖蛋白的影响

目的探讨血凝酶对体外循环（CPB）心内直视术患者血小板膜糖蛋白的影响。方法将30例室间隔缺损患儿随机分为血凝酶组（n=15）与空白组（n=15）。血凝酶组于麻醉诱导后至CPB前经中心静脉缓慢静注血凝酶1kU，另1kU加入预充液中随机转入体内；空白组以等容量生理盐水代替血凝酶，方法同血凝酶组。监测2组患者主动脉阻断时间、CPB时间以及切皮前（T1）、CPB开始后30min（T2）、鱼精蛋白中和肝素后20min（T3）、CPB后1h（T4）的血小板（PLT）、GPIb、GPⅡb／Ⅲa、GMP-140变化；记录术后1、3、6h心包纵隔引流量。结果PLT值血凝酶组T2、T3、T4显著高于空白组（P〈0．05）；GMP-140血凝酶组T2、T3、T4显著低于空白组（P〈0．05）；GPⅠbN凝酶组T2、T3、T4显著高于空白组（P〈0．05）；GPⅡb／Ⅲa2组比较，T2、T3、T4差异无统计学意义（P〉0．05）；2组术后1h心包纵隔引流量无明显差异（P〉0．05），术后3、6h血凝酶组显著低于空白组（P〈0．05）。结论血凝酶能在一定程度上抑制CPB心内直视术患者血小板的激活，积极保护GPIb，减少CPB术后出血。

The Impact of Hemocoagulase on Platelet Membrane Glycoproteins in Patients Undergone Intracardiac Surgery with Cardiopulmonary Bypass

Objective To study the impact of hemocoagulase on platelet membrane glycoproteins in patients undergone intracardiac surgery with cardiopulmonary bypass（CPB）. Methods Thirty parvuses suffered VSD were randomly divided into hemocoagulase group（n= 15）and control group（n= 15）. One kU of hemocoagulase was injected intravenously into the patients in hemocoagulase group through central vein from the anesthesia induction to the beging of CPB. Another 1 kU of hemocoagulase was addined priming solution and entered corpore with CPB. The hemocoagulase was replaced with the same volume sodium chloride in the control group. The time of aorta blocking and CPB were recored, detected The levels of PLT, the percentage of GMP-140, GP I b and the GP Ⅰ b/Ⅲa were detected pre-skin incision（T1 ）,30 mins after CPB（T2 ）,20 mins after the neutralization heparin with protamine （T3） and 1 h after CPB （T4） respectively. The drainage volume of arcula cordis and mediastinum was record at 1,3,6 h post-operation. Results The values of PLT in the hemocoagulase group at T2, T3 and T4 were significantly higher than these in the control group（all P〈0.05）. The values of GMP-140 in the hemocoagulase group at T2 ,T3 and T4 were significantly lower than these in the control group（all P〈0.05）. The values of GP l b in the hemocoagulase group at T2 ,T3 and T4 were significantly higher than these in the control group（P〈0.05）. There was no significant difference between the values of GP Ⅱ b/Ⅲ a in two groups（P〉0.05）. There was no significant difference between the drainage volume of arcula cordis and mediastinum in two groups at 1 h post-operation（P〉 0. 05）. Whereas, both of the drainage volumes of arcula cordis and mediastinum at 3 h and 6h post-operation in the hemocoagulase group were significantly lower than these in the control group（P〈0.05）. Conclusions Hemocoagulase could inhibit the activation of platelet in patients undergone intracardiac surgery with CPB. It has positive protective role for the GP I b, thus to decrease the bleeding after CPB.