Omokawa S, Malchesky P S, Yamashita M, Suzuki T, Goldcamp J G, Murabayashi S, Nosè Y
Department of Artificial Organs, Cleveland Clinic Foundation, Ohio.
Int J Artif Organs. 1990 Nov;13(11):768-77.
The effect of heparin or citrate anticoagulation on blood cellular, complement pathway and coagulation pathway was investigated in a membrane plasma exchange procedure. Two membrane plasma separators constructed of cellulose di-acetate (CA) and polyvinyl chloride (PVC) were evaluated with heparin or citrate alone for anticoagulation in a 26 year old male with myasthenia gravis. Maximum white blood cell counts decrease was 21% at 30 min for the CA with heparin while no decrease was observed for the other schemes. Platelet counts changes were comparable between heparin and citrate, while the PVC groups showed less changes than the CA groups. The CA groups, regardless of the type of anticoagulant used, indicated that complement activation occurred via the classical pathway within the module in addition to the activation via alternative pathway for the CA with heparin. In the PVC groups, complement activation was noted to occur only when heparin was used for anticoagulation. PT and PTT showed slight increases with citrate, while they were remarkably prolonged with heparin. Citrate showed less changes in cellular and humoral factors compared to heparin. CA with heparin was the most activating combination of membrane material and anticoagulant, while the PVC with citrate was the least activating combination.
在膜式血浆置换过程中，研究了肝素或枸橼酸盐抗凝对血细胞、补体途径和凝血途径的影响。使用由二醋酸纤维素（CA）和聚氯乙烯（PVC）制成的两种膜式血浆分离器，对一名26岁重症肌无力男性患者单独使用肝素或枸橼酸盐进行抗凝评估。使用肝素的CA在30分钟时白细胞计数最大降幅为21%，而其他方案未观察到下降。肝素和枸橼酸盐组的血小板计数变化相当，但PVC组的变化小于CA组。CA组，无论使用何种抗凝剂类型，表明除了使用肝素的CA通过替代途径激活外，模块内还通过经典途径发生补体激活。在PVC组中，仅在使用肝素抗凝时才观察到补体激活。枸橼酸盐使PT和PTT略有增加，而肝素使其显著延长。与肝素相比，枸橼酸盐在细胞和体液因子方面的变化较小。肝素化的CA是膜材料和抗凝剂最具激活作用的组合，而枸橼酸盐抗凝的PVC是激活作用最小的组合。
