Harig F, Meier C, Hakami L, Strasser R, Bretzger J, Münch F, Vestweber-Wilmes E, Singer H, Weyand M, Cesnjevar R
Center of Cardiac Surgery, University Hospital Erlangen, Erlangen, Germany.
Thorac Cardiovasc Surg. 2006 Apr;54(3):168-72. doi: 10.1055/s-2005-872863.
Modified ultrafiltration (MUF) has been shown to exert beneficial effects on the coagulation system and the capillary leak after pediatric cardiac surgery using extracorporeal circulation (ECC). The aim of this study was to investigate whether the additional use of heparin-coated circuits is a useful option for improving biocompatibility.
We randomized 28 children, using heparin-coated ECC circuits in group A (n = 14) and an uncoated equivalent set in group B (n = 14). After congenital heart surgery, MUF was performed post ECC in a standardized fashion. Blood samples were analyzed preoperatively, 10 min, 30 min, 1 h, and 48 h after ECC by flow cytometric analysis (FACSort) using surface antigens CD62/CD41b (platelets) and CD45/CD14 (monocytes).
No significant difference was found with respect to mean age (20.6 months vs. 21.6 months), mean body weight (9.2 kg vs. 8.4 kg), mean ultrafiltration rate (9.1 ml/kg vs. 11.4 ml/kg), chest tube drainage, blood products, ICU stay, and 30-d survival. The percentage of CD62/CD41-positive platelets in group A (vs. B) increased up to 118 % at 60 min vs. 130 % ( P < 0.05) and declined to 98 % at 48 h postop. vs. 99 % (n. s.). The percentage of CD45/CD14-positive monocytes in group A (vs. B) increased up to 158 % at 60 min vs. 155 % (n. s.) and declined to 122 % (A) at 48 h postop. vs. 61 % (B) ( P > 0.05).
Heparin coating of ECC in addition to MUF leads to a lower platelet activation. Monocyte surface markers CD45 and CD14 indicated a marked activation during ECC in both groups but additional heparin coating showed a better postoperative regeneration of monocyte markers in the late course indicating a beneficial additive effect.
改良超滤（MUF）已被证明对小儿体外循环（ECC）心脏手术后的凝血系统和毛细血管渗漏有有益影响。本研究的目的是调查额外使用肝素涂层回路是否是改善生物相容性的有用选择。
我们将28名儿童随机分组，A组（n = 14）使用肝素涂层ECC回路，B组（n = 14）使用未涂层的同等装置。先天性心脏手术后，以标准化方式在ECC后进行MUF。术前、ECC后10分钟、30分钟、1小时和48小时采集血样，通过流式细胞术分析（FACSort）使用表面抗原CD62/CD41b（血小板）和CD45/CD14（单核细胞）进行分析。
在平均年龄（20.6个月对21.6个月）、平均体重（9.2千克对8.4千克）、平均超滤率（9.1毫升/千克对11.4毫升/千克）、胸管引流、血液制品、重症监护病房停留时间和30天生存率方面未发现显著差异。A组（对比B组）CD62/CD41阳性血小板百分比在60分钟时增加至118%，对比130%（P < 0.05），术后48小时降至98%，对比99%（无显著差异）。A组（对比B组）CD45/CD14阳性单核细胞百分比在60分钟时增加至158%，对比155%（无显著差异），术后48小时降至122%（A组），对比61%（B组）（P > 0.05）。
除MUF外，ECC的肝素涂层导致较低的血小板活化。单核细胞表面标志物CD45和CD14表明两组在ECC期间均有明显活化，但额外肝素涂层在后期显示出更好的单核细胞标志物术后再生，表明有有益的相加作用。
