De Mol Van Otterloo J C, Van Bockel J H, Ponfoort E D, Briet E, Brommer E J, Hermans J, Daha M R
Department of Surgery, University Hospital Leiden, The Netherlands.
J Vasc Surg. 1991 Jul;14(1):59-66.
To minimize intraoperative blood loss a watertight knitted Dacron aortoiliac prosthesis has been developed by impregnation with bovine collagen. A potential disadvantage is that collagen may be associated with an increase in thrombus formation. We conducted a prospective randomized trial to study the systemic effects of collagen-impregnated prostheses and of aortoiliac operation as such on the coagulation mechanism during the first 10 days after operation. Forty-one patients randomly received either a collagen-impregnated (n = 20) or a nonimpregnated prosthesis (n = 21). Twelve patients who underwent cholecystectomies served as controls. Three markers of the coagulation mechanism were monitored: beta-thromboglobulin, fibrinopeptide A, and fibrin/fibrinogen degradation products. We found no significant differences in median beta-thromboglobulin, fibrinopeptide A, and fibrin/fibrinogen degradation product levels between patients in the collagen-impregnated prosthesis group and patients in the nonimpregnated prosthesis group. This indicates that collagen does not stimulate the coagulation cascade any more than conventional Dacron protheses do. In a comparison of patients who underwent aortoiliac reconstruction and patients who underwent cholecystectomies, the results indicated a significant increased platelet activation and fibrin metabolism in aortoiliac reconstruction group compared with the control group. Finally, we observed a significantly higher preoperative fibrin metabolism in patients with vascular disease than in control subjects. This difference is attributable to the high preoperative fibrin/fibrinogen degradation product values in patients with aortic aneurysms.
为了尽量减少术中失血，已通过用牛胶原蛋白浸渍开发出一种防水编织涤纶主髂动脉假体。一个潜在的缺点是胶原蛋白可能与血栓形成增加有关。我们进行了一项前瞻性随机试验，以研究胶原蛋白浸渍假体以及主髂动脉手术本身对术后前10天凝血机制的全身影响。41例患者随机接受胶原蛋白浸渍假体（n = 20）或未浸渍假体（n = 21）。12例行胆囊切除术的患者作为对照。监测了凝血机制的三个标志物：β-血小板球蛋白、纤维蛋白肽A和纤维蛋白/纤维蛋白原降解产物。我们发现，胶原蛋白浸渍假体组患者与未浸渍假体组患者的β-血小板球蛋白、纤维蛋白肽A和纤维蛋白/纤维蛋白原降解产物水平中位数无显著差异。这表明胶原蛋白对凝血级联反应的刺激并不比传统涤纶假体更大。在对接受主髂动脉重建的患者和接受胆囊切除术的患者进行比较时，结果表明，与对照组相比，主髂动脉重建组患者的血小板活化和纤维蛋白代谢显著增加。最后，我们观察到血管疾病患者术前纤维蛋白代谢明显高于对照组。这种差异归因于主动脉瘤患者术前纤维蛋白/纤维蛋白原降解产物值较高。
