Nathan N, Denizot Y, Feiss P, Cornu E, Benveniste J, Arnoux B
Department of Anaesthesiology, CHU Dupuytren, Limoges, France.
Acta Anaesthesiol Scand. 1992 Apr;36(3):264-9. doi: 10.1111/j.1399-6576.1992.tb03462.x.
The potent inflammatory mediator PAF-acether (PAF = platelet-activating factor) can produce the same hemodynamic and hematological effects as protamine infusion. In 10 patients, blood PAF and precursor levels were measured in the left atrium, the pulmonary and the radial artery before and after protamine reversal of heparin during coronary artery bypass graft. Blood PAF level in the left atrium increased 6-fold (17 +/- 12 pg.ml-1 vs 98 +/- 46 pg.ml-1, P = 0.03) after protamine infusion. By contrast, a 4-fold decrease was observed in the pulmonary artery blood (130 +/- 48 pg.ml-1 vs 31 +/- 23 pg.ml-1, P = 0.03) and a 9-fold decrease was noted in the radial artery blood (285 +/- 104 pg.ml-1 vs 31 +/- 15 pg.ml-1, P = 0.01). No cardiovascular impairment was observed but all patients exhibited thrombocytopenia. After protamine, PAF in the left atrium reached lower levels than those observed in the pulmonary and radial artery before protamine infusion. Moreover, no significant correlation was observed between platelet counts and PAF levels. Thus PAF seems not to mediate the platelet drop induced by heparin-protamine complexes. A positive correlation was obtained between leukocyte counts in the pulmonary artery and PAF levels in the left atrium (r = 0.78, P = 0.02). Protamine infusion may stimulate PAF biosynthesis by leukocytes in the lung, on the one hand, and accelerate the disappearance of PAF in the arterial bed, on the other hand.
强效炎症介质血小板活化因子（PAF = 血小板激活因子）可产生与输注鱼精蛋白相同的血液动力学和血液学效应。在10例患者中，于冠状动脉搭桥手术期间肝素经鱼精蛋白逆转前后，测量了左心房、肺动脉和桡动脉中的血液PAF及前体水平。输注鱼精蛋白后，左心房血液PAF水平升高了6倍（17±12 pg.ml-1对比98±46 pg.ml-1，P = 0.03）。相比之下，肺动脉血液中观察到4倍的下降（130±48 pg.ml-1对比31±23 pg.ml-1，P = 0.03），桡动脉血液中则出现9倍的下降（285±104 pg.ml-1对比31±15 pg.ml-1，P = 0.01）。未观察到心血管功能损害，但所有患者均出现血小板减少。鱼精蛋白输注后，左心房中的PAF水平低于输注鱼精蛋白前在肺动脉和桡动脉中观察到的水平。此外，血小板计数与PAF水平之间未观察到显著相关性。因此，PAF似乎并不介导肝素 - 鱼精蛋白复合物诱导的血小板减少。肺动脉中的白细胞计数与左心房中的PAF水平之间呈正相关（r = 0.78，P = 0.02）。一方面，输注鱼精蛋白可能刺激肺中白细胞的PAF生物合成，另一方面，加速动脉床中PAF的消失。
