Nathan N, Aissa J, Benveniste J, Arnoux B
INSERM U200, Clamart, France.
Eur J Anaesthesiol. 1992 Jul;9(4):347-52.
The effects of protamine (6 mg kg-1) injected after heparin (5 mg kg-1) have been studied in five groups of five New Zealand white rabbits. Group I was treated with the sequence heparin-protamine and group II with protamine alone. The animals of groups III and IV received respectively intravenous indomethacin (3 mg kg-1) and BN 52021 (3 mg kg-1), a paf receptor antagonist before the sequence heparin-protamine. Group V was pre-treated with indomethacin and BN 52021 before heparin reversal with protamine. In group I, immediate thrombocytopenia (44.1 +/- 4.6% of baseline level, P less than 0.05) and leucopenia (55.5 +/- 2.3% of baseline level, P less than 0.05) were observed 30 s after protamine reversal of heparin, paralleled with an increase in blood paf levels (27.6 +/- 27.6 vs. 148.2 +/- 48.9 pg ml-1, P less than 0.05). In group II, protamine alone induced no change in platelet count nor in blood paf levels (55 +/- 10 vs. 52.5 +/- 20 pg ml-1, P greater than 0.05). Pre-treatment with indomethacin alone (group III) did not protect the animals against the haematological changes induced by the heparin-protamine complexes. Pre-treatment with the paf receptor antagonist, alone or in association with indomethacin, delayed the occurrence of thrombocytopenia 3 min after protamine administration but the leucopenia was the same as in group I. This study demonstrated that paf is implicated in the immediate thrombocytopenia occurring after protamine reversal of heparin in rabbit.
在五组每组五只新西兰白兔中研究了在注射肝素(5毫克/千克)后注射鱼精蛋白(6毫克/千克)的效果。第一组按肝素-鱼精蛋白顺序治疗,第二组仅用鱼精蛋白治疗。第三组和第四组动物在肝素-鱼精蛋白顺序治疗前分别静脉注射消炎痛(3毫克/千克)和BN 52021(3毫克/千克),一种血小板活化因子受体拮抗剂。第五组在鱼精蛋白用于肝素逆转前用消炎痛和BN 52021进行预处理。在第一组中,肝素被鱼精蛋白逆转后30秒观察到立即出现血小板减少(降至基线水平的44.1±4.6%,P<0.05)和白细胞减少(降至基线水平的55.5±2.3%,P<0.05),同时血液中血小板活化因子水平升高(27.6±27.6对148.2±48.9皮克/毫升,P<0.05)。在第二组中,仅鱼精蛋白未引起血小板计数和血液中血小板活化因子水平的变化(55±10对52.5±20皮克/毫升,P>0.05)。单独用消炎痛预处理(第三组)不能保护动物免受肝素-鱼精蛋白复合物引起的血液学变化。单独或与消炎痛联合使用血小板活化因子受体拮抗剂进行预处理,可延迟鱼精蛋白给药后3分钟血小板减少的发生,但白细胞减少情况与第一组相同。本研究表明,血小板活化因子与兔体内肝素被鱼精蛋白逆转后立即出现的血小板减少有关。