Tanemoto K, Hamanaka S, Morita I, Masaki H
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kasawaki Medical School, Okayama, Japan.
J Cardiovasc Surg (Torino). 2004 Feb;45(1):27-30.
We measured the platelet count and platelet function in residual blood in the cardiopulmonary bypass (CPB) circuit after cpb and compared them with data before CPB operation.
The subjects included 34 cases of patients subjected to CPB surgery. The residual blood was concentrated by ultrafiltration after CPB, collected in the bag and the platelet count and platelet activity was measured. ADP 2, 5, 10 microM was used as agonists and measurement was made by turbidimetry.
The mean value of the platelet count was 18.3+/-5.65x10(4)/mm(3) before surgery and 17.2+/-8.39x10(4)/mm(3) in the residual blood, there is no difference. Concerning the platelet aggregation activity, the maximum aggregation rate decreased significantly with ADP 2 microM from 47.4+/-19.6% before surgery to 27.1+/-17.2% in the residual blood (p<0.01). Likewise, it decreased significantly with ADP 5 and 10 microM. The reduction rate of the platelet aggregation activity was higher in the group of not less than 100 minutes compared with the group of less than 100 minutes, but no significant difference was found.
Autotransfusing whole blood per se without the "cell saver" treatment is more advantageous to keep hemostasis function after surgery since many platelets having the aggregation activity exist in residual blood in the CPB circuit.
我们测量了体外循环(CPB)后CPB回路中残余血液的血小板计数和血小板功能,并将其与CPB手术前的数据进行比较。
受试者包括34例行CPB手术的患者。CPB后通过超滤浓缩残余血液,收集于袋中并测量血小板计数和血小板活性。使用2、5、10微摩尔/升的二磷酸腺苷(ADP)作为激动剂,采用比浊法进行测量。
术前血小板计数平均值为18.3±5.65×10⁴/mm³,残余血液中为17.2±8.39×10⁴/mm³,无差异。关于血小板聚集活性,使用2微摩尔/升ADP时,最大聚集率从术前的47.4±19.6%显著降至残余血液中的27.1±17.2%(p<0.01)。同样,使用5和10微摩尔/升ADP时也显著降低。与CPB时间小于100分钟的组相比,CPB时间不少于100分钟的组血小板聚集活性降低率更高,但差异无统计学意义。
由于CPB回路中的残余血液中存在许多具有聚集活性的血小板,在未进行“血液回收机”处理的情况下自体回输全血本身更有利于术后维持止血功能。