Osada T, Kawachi K, Uchino T, Hirayama T, Ishimaru S, Furukawa K
Department of Cardiovascular Surgery, Tokyo Medical College Hachioji Medical Center, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1992 Jul;40(7):1100-4.
Cold-reactive proteins, such as cold agglutinins, cryoglobulins, and cryofibrinogens, are reversibly precipitates, or gel, upon exposure to cold temperatures. Cryoglobulins are usually not of importance, but under special conditions, such as surgical hypothermia, hyperviscosity and damage in microcirculation may occur in patients with high plasma concentration of cryoglobulins. Several groups have reported their efforts to reduce further the risks of surgical hypothermia in patients with cold agglutinins, but rarely in patients with cryoglobulins. A 57-year-old woman with thoracic aneurysm, requiring replacement of the ascending aorta and the aortic arch, had mixed cryoglobulinemia (cryocrit 29%) associated with rheumatoid arthritis. Steroids therapy and preoperative plasmapheresis were performed, and cryocrit levels were decreased until 0% before operation. Systemic hypothermia (25 degrees C), hemodilution techniques during cardiopulmonary bypass, and cold crystalloid cardioplegia were successfully employed, and no clinical evidence of microcirculation damage was posed after operation.
冷反应蛋白，如冷凝集素、冷球蛋白和冷纤维蛋白原，在暴露于低温时会可逆性沉淀或形成凝胶。冷球蛋白通常并不重要，但在特殊情况下，如手术性低温时，血浆冷球蛋白浓度高的患者可能会出现高黏滞血症和微循环损伤。已有多个研究小组报告了他们为进一步降低冷凝集素患者手术性低温风险所做的努力，但针对冷球蛋白患者的研究很少。一名57岁患有胸主动脉瘤、需要置换升主动脉和主动脉弓的女性患者，患有与类风湿关节炎相关的混合型冷球蛋白血症（冷球蛋白比容29%）。进行了类固醇治疗和术前血浆置换，术前冷球蛋白比容水平降至0%。成功采用了全身低温（25℃）、体外循环期间的血液稀释技术以及冷晶体心脏停搏液，术后未出现微循环损伤的临床证据。
