Ballotta Andrea, Saleh Hisham Z, El Baghdady Hisham W, Gomaa Magdi, Belloli Federica, Kandil Hassan, Balbaa Yahia, Bettini Fabrizio, Bossone Eduardo, Menicanti Lorenzo, Frigiola Alessandro, Bellucci Carmen, Mehta Rajendra H
Department of Cardiac Surgery and Critical Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
J Thorac Cardiovasc Surg. 2007 Jul;134(1):132-8. doi: 10.1016/j.jtcvs.2007.01.055.
Cardiopulmonary bypass has been shown to be associated with platelet dysfunction, which has a potential for increasing the risk of perioperative bleeding. Off-pump coronary artery bypass surgery is thought to avoid this deleterious effect of pump use on platelets. However, the influence of off-pump coronary artery bypass surgery on platelets has not been thoroughly studied.
Accordingly, we evaluated 60 patients undergoing coronary artery bypass grafting prospectively using cardiopulmonary bypass and warm cardioplegic arrest (n = 30) or an off-pump technique (n = 30). Platelet function was evaluated before and 2 hours after coronary artery bypass grafting.
Among patients undergoing on-pump coronary artery bypass surgery, all studies of platelet function were significantly abnormal after surgical intervention compared with results before surgical intervention. Similarly, among patients undergoing off-pump coronary artery bypass surgery, evidence of platelet dysfunction after surgical intervention was noted, with a lower platelet count and a higher proportion of P-selectin- and Annexin V-positive platelets. However, compared with the preprocedural value, the postprocedural decrease in platelet count (78,200 x 10(3)/microL vs 103,000 x 10(3)/microL) and platelet aggregation (0.8% vs 10.9%) and increase in bleeding time (0 minutes vs +1.3 minutes), P-selectin-positive platelets (6.0% vs 9.1%), and Annexin V-positive platelets (1.7% vs 3.7%) were significantly lower in the off-pump coronary artery bypass surgery group compared with those in the on-pump coronary artery bypass surgery group, respectively.
Early postoperative decrease in platelet count and increase in platelet activation occurs to a much lesser extent and does not alter bleeding time or adenosine diphosphate-induced platelet aggregation in patients undergoing off-pump coronary artery bypass surgery. This lack of significant effects on platelets might in part account for the potential decreased risk in bleeding and for the preserved hemostasis seen in patients undergoing off-pump coronary artery bypass surgery compared with those undergoing on-pump coronary artery bypass grafting surgery.
体外循环已被证明与血小板功能障碍有关，这有可能增加围手术期出血的风险。非体外循环冠状动脉搭桥手术被认为可避免使用体外循环对血小板产生的这种有害影响。然而，非体外循环冠状动脉搭桥手术对血小板的影响尚未得到充分研究。
因此，我们前瞻性地评估了60例行冠状动脉搭桥术的患者，其中30例使用体外循环和温血心脏停搏技术，30例采用非体外循环技术。在冠状动脉搭桥术前和术后2小时评估血小板功能。
在接受体外循环冠状动脉搭桥手术的患者中，与手术干预前的结果相比，所有血小板功能研究在手术干预后均显著异常。同样，在接受非体外循环冠状动脉搭桥手术的患者中，也注意到手术干预后血小板功能障碍的证据，表现为血小板计数降低以及P-选择素和膜联蛋白V阳性血小板比例升高。然而，与术前值相比，非体外循环冠状动脉搭桥手术组术后血小板计数的下降（78,200×10³/μL对103,000×10³/μL）和血小板聚集（0.8%对10.9%）以及出血时间的增加（0分钟对+1.3分钟）、P-选择素阳性血小板（6.0%对9.1%）和膜联蛋白V阳性血小板（1.7%对3.7%）分别显著低于体外循环冠状动脉搭桥手术组。
非体外循环冠状动脉搭桥手术患者术后早期血小板计数下降和血小板活化增加的程度要小得多，且不会改变出血时间或二磷酸腺苷诱导的血小板聚集。与接受体外循环冠状动脉搭桥手术的患者相比，对血小板缺乏显著影响可能部分解释了非体外循环冠状动脉搭桥手术患者出血风险潜在降低以及止血功能得以保留的原因。
