Wickey G S, Keifer J C, Larach D R, Diaz M R, Williams D R
Department of Anesthesia, University Hospital, Pennsylvania State University College of Medicine, Hershey.
J Thorac Cardiovasc Surg. 1992 Jun;103(6):1172-6.
Records of anticoagulation for cardiopulmonary bypass from 58 patients who underwent elective coronary artery revascularization were analyzed to determine whether the harvesting of autologous platelet-rich plasma produces heparin resistance. The effect of preoperative heparin therapy on anticoagulation for cardiopulmonary bypass after harvesting of platelet-rich plasma was also evaluated. Patients were grouped by presence of preoperative heparin therapy and type of blood component harvested before cardiopulmonary bypass, including platelet-rich plasma, autologous whole blood, both, or neither. The dose of heparin required to initiate and to maintain anticoagulation for cardiopulmonary bypass was determined for each patient, and the groups were compared by two-way analysis of variance. Significantly more heparin was required to maintain anticoagulation for cardiopulmonary bypass in the platelet-rich plasma group than in the groups receiving autologous whole blood or no blood products. More heparin was also required to initiate and to maintain anticoagulation for cardiopulmonary bypass after preoperative heparin therapy. These results reinforce the concept that anticoagulation during cardiopulmonary bypass must be carefully monitored, and increased vigilance may be warranted in patients after harvesting of platelet-rich plasma.
分析了58例行择期冠状动脉血运重建术患者的体外循环抗凝记录，以确定采集自体富血小板血浆是否会产生肝素抵抗。还评估了术前肝素治疗对采集富血小板血浆后体外循环抗凝的影响。根据术前肝素治疗的情况以及体外循环前采集的血液成分类型（包括富血小板血浆、自体全血、两者都采集或两者都不采集）对患者进行分组。确定每位患者启动和维持体外循环抗凝所需的肝素剂量，并通过双向方差分析对各组进行比较。与接受自体全血或未接受血液制品的组相比，富血小板血浆组维持体外循环抗凝所需的肝素显著更多。术前肝素治疗后，启动和维持体外循环抗凝也需要更多的肝素。这些结果强化了这样一个概念，即体外循环期间的抗凝必须仔细监测，对于采集富血小板血浆后的患者可能需要提高警惕。
