Department of Cardiopulmonary Bypass, Cardiovascular Institute and Fuwai Hospital, CAMS and PUMS, Beijing, China.
Artif Organs. 2009 Nov;33(11):909-14. doi: 10.1111/j.1525-1594.2009.00914.x.
This study investigated features and treatments of perioperative coagulopathies in cyanotic infants with complex congenital heart disease (CCHD). Thirty-six infants with cyanotic CCHD were involved and divided into two groups: In group H (n = 20), hematocrit (HCT) > 54%, and in group L (n = 16), HCT < 54%. Blood was sampled at anesthesia induction (T1), rewarming to 36 degrees C (T2), after heparin neutralization (T3), and 4 h after operation (T4). The hemostatic changes were evaluated by thromboelastograph (TEG). After surgery, group H was treated with fibrinogen-combined platelets (PLT), while group L was treated with PLT only. We observed the effect at T4. At T1, the hemostatic function in group H, deteriorating with the increase of HCT (P < 0.01), was obviously lower than that in group L (P < 0.01), but the PLT function was still complete. In group H, the hemostatic function at T2 decreased with a significant drop of PLT function (P < 0.01) and had little change of functional fibrinogen (Ffg) (P > 0.05). At T3, compared with T2, there were improvements in hemostatic function and Ffg (P < 0.01, respectively) without increase of PLT (P > 0.05) in group H. After therapy, PLT function in both groups restored to T1 level (P > 0.05); Ffg at T4 was significantly better than at T1 (P < 0.01) in group H, but Ffg at T4 with still normal function was lower than at T1 in group L (P < 0.01). Whole hemostatic function at T4 was back to normal and had no differences between two groups. So, we proposed that fibrinogen and PLT transfusion in combination should be better for infants with high HCT CCHD, but PLT alone might be enough for low HCT ones.
本研究旨在探讨紫绀型复杂先天性心脏病（CCHD）患儿围手术期凝血功能障碍的特点和治疗方法。共纳入 36 例紫绀型 CCHD 患儿，分为 H 组（n = 20）和 L 组（n = 16）。H 组的红细胞压积（HCT）> 54%，L 组的 HCT < 54%。分别在麻醉诱导时（T1）、复温至 36°C 时（T2）、肝素中和后（T3）和手术后 4 小时（T4）采血。通过血栓弹性图（TEG）评估止血变化。手术后，H 组给予纤维蛋白原联合血小板（PLT）治疗，L 组仅给予 PLT 治疗。我们观察了 T4 时的疗效。T1 时，H 组的凝血功能随 HCT 的增加而恶化（P < 0.01），明显低于 L 组（P < 0.01），但 PLT 功能仍完整。H 组 T2 时的凝血功能随 PLT 功能的显著下降而下降（P < 0.01），功能纤维蛋白原（Ffg）变化不大（P > 0.05）。T3 时，与 T2 相比，H 组的凝血功能和 Ffg 均有改善（P < 0.01，分别），PLT 无增加（P > 0.05）。两组治疗后 PLT 功能均恢复至 T1 水平（P > 0.05）；H 组 T4 时的 Ffg 明显优于 T1 时（P < 0.01），但 L 组 T4 时的 Ffg 仍正常，低于 T1 时（P < 0.01）。T4 时整体止血功能恢复正常，两组间无差异。因此，我们建议高 HCT CCHD 患儿应联合输注纤维蛋白原和 PLT，但低 HCT 患儿单独输注 PLT 可能就足够了。
