Chandler Wayne L
Department of Laboratory Medicine, University of Washington, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104, USA.
J Cardiothorac Vasc Anesth. 2005 Aug;19(4):459-67. doi: 10.1053/j.jvca.2004.11.046.
The purpose of this study was to determine quantitatively the effects of consumption, hemodilution, and blood loss on coagulation and fibrinolytic factor levels during cardiopulmonary bypass.
A combination of measured levels of prothrombin, antithrombin, fibrinogen, plasminogen, and antiplasmin along with their activation markers F1.2, thrombin-antithrombin complex, fibrinopeptide A, plasmin-antiplasmin complex, and D-dimer were used with a computer model of each patient's vascular and hemostatic systems to estimate the cardiopulmonary bypass-associated loss of each factor because of hemodilution, blood loss, and consumption.
University hospital.
Nine patients undergoing coronary artery bypass graft surgery.
None.
At baseline, it was estimated that on average 2%, 3%, and 25%, respectively, of the baseline liver secretion of plasminogen, prothrombin,and fibrinogen were consumed by activation of these proteins. During cardiopulmonary bypass, thrombin and plasmin generation were increased, whereas fibrin generation was decreased because of heparin. Compared with baseline, hemodilution during cardiopulmonary bypass resulted in an average 35% +/- 7% decrease in the concentration of coagulation and fibrinolytic proteins, whereas blood loss was responsible for an average 6% +/- 5% decrease in these proteins. Blood loss varied substantially among patients, resulting in <1% to 14% decreases in hemostatic protein levels. On average, consumption because of activation resulted in less than a 1% drop in the concentration of coagulation and fibrinolytic factors during cardiopulmonary bypass.
Hemodilution is the primary cause of the drop in coagulation and fibrinolytic proteins during routine cardiopulmonary bypass, followed by blood loss, whereas consumption accounts for less than a 1% drop in most patients.
本研究旨在定量测定体外循环期间消耗、血液稀释和失血对凝血及纤溶因子水平的影响。
将凝血酶原、抗凝血酶、纤维蛋白原、纤溶酶原和抗纤溶酶的测定水平及其激活标志物F1.2、凝血酶 - 抗凝血酶复合物、纤维蛋白肽A、纤溶酶 - 抗纤溶酶复合物和D - 二聚体与每位患者血管和止血系统的计算机模型相结合，以估计由于血液稀释、失血和消耗导致的体外循环相关各因子的损失。
大学医院。
9例接受冠状动脉旁路移植手术的患者。
无。
在基线时，估计纤溶酶原、凝血酶原和纤维蛋白原的基线肝脏分泌量分别平均有2%、3%和25%因这些蛋白质的激活而被消耗。在体外循环期间，凝血酶和纤溶酶生成增加，而由于肝素的作用，纤维蛋白生成减少。与基线相比，体外循环期间的血液稀释导致凝血和纤溶蛋白浓度平均下降35%±7%，而失血导致这些蛋白质平均下降6%±5%。患者之间失血量差异很大，导致止血蛋白水平下降<1%至14%。平均而言，体外循环期间因激活导致的消耗使凝血和纤溶因子浓度下降不到1%。
血液稀释是常规体外循环期间凝血和纤溶蛋白下降的主要原因，其次是失血，而在大多数患者中，消耗导致的下降不到1%。
