Boldt J, Zickmann B, Czeke A, Herold C, Dapper F, Hempelmann G
Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Federal Republic of Germany.
Anesthesiology. 1991 Sep;75(3):426-32. doi: 10.1097/00000542-199109000-00008.
Postoperative alterations in platelet function induced by cardiopulmonary bypass (CPB) are of importance. The effect on platelet aggregation of three different techniques for reducing blood consumption was studied in 30 patients undergoing elective aortocoronary bypass grafting from the beginning of anesthesia until the 1st postoperative day. The patients were randomly divided into three groups, in which 1) a cell separator was used during and after CPB; 2) a hemofiltration device was used; and 3) high-dose aprotinin was used in order to reduce the need of homologous blood. A fourth group undergoing neurosurgery procedures served as a control. Platelet aggregation induced by adenosine diphosphate (concentration 0.25, 0.50, 1.0, and 2.0 microM), collagen (4 microliters/ml), and epinephrine (25 microM) was determined by the turbidimetric method. Platelet aggregation was not significantly changed in the control group, indicating that the operation itself did not impair platelet function. At the end of the operation (after retransfusion of the salvaged pump blood), the maximum aggregation and maximum gradient of aggregation induced by all three inductors were most reduced (significantly) in the cell-separator patients. On the 1st postoperative day, platelet aggregation in the hemofiltration patients and the patients treated with aprotinin had normalized. Aggregation of patients pretreated with high-dose aprotinin was not different from that of the hemofiltration patients throughout the investigation. Blood loss was significantly highest in the cell-separator group (770 +/- 400 ml on the 1st postoperative day) but was not different between the hemofiltration (390 +/- 230 ml) and the aprotinin-treated patients (260 +/- 160 ml).(ABSTRACT TRUNCATED AT 250 WORDS)
体外循环（CPB）引起的术后血小板功能改变具有重要意义。在30例择期主动脉冠状动脉搭桥手术患者中，从麻醉开始至术后第1天，研究了三种不同减少血液消耗技术对血小板聚集的影响。患者被随机分为三组，其中1）在CPB期间及之后使用细胞分离器；2）使用血液滤过装置；3）使用高剂量抑肽酶以减少对同源血的需求。第四组接受神经外科手术作为对照。通过比浊法测定二磷酸腺苷（浓度0.25、0.50、1.0和2.0微摩尔）、胶原（4微升/毫升）和肾上腺素（25微摩尔）诱导的血小板聚集。对照组血小板聚集无明显变化，表明手术本身未损害血小板功能。手术结束时（回输回收的泵血后），细胞分离器组患者中，所有三种诱导剂诱导的最大聚集和最大聚集梯度下降最为显著。术后第1天，血液滤过患者和接受抑肽酶治疗患者的血小板聚集已恢复正常。在整个研究过程中，高剂量抑肽酶预处理患者的聚集与血液滤过患者无异。细胞分离器组失血明显最多（术后第1天为770±400毫升），但血液滤过组（390±230毫升）和抑肽酶治疗患者（260±160毫升）之间无差异。（摘要截短于250字）
