Kappa J R, Musial J, Fisher C A, Addonizio V P
J Surg Res. 1987 Jan;42(1):10-8. doi: 10.1016/0022-4804(87)90058-8.
Extensive blood-synthetic surface interactions during cardiopulmonary bypass produce adverse platelet alterations that can contribute to excessive blood loss following open cardiac surgery. These platelet alterations can be reduced by temporary inhibition of platelet function. In order to define further an optimal method of platelet inhibition during blood-synthetic surface contact, we quantitated platelet functional and structural alterations that occur during simulated extracorporeal circulation (SEC) despite platelet inhibition with Iloprost (ZK) or PGE1. Five-hundred milliliters of fresh heparinized human blood were recirculated for 2 hr in a circuit consisting of silicone rubber components and a spiral coil membrane oxygenator. When blood was recirculated for 2 hr without drug, platelet counts fell significantly to 46 +/- 7% (mean +/- SEM) of initial levels (P less than 0.01); mean platelet volume decreased from 6.90 +/- 0.25 micron3 to 6.05 +/- 0.33 micron3 (P less than 0.01); platelet dispersion increased from 1.73 +/- 0.02 to 2.14 +/- 0.09 (P less than 0.01) and platelets no longer aggregated in response to epinephrine or thrombin. In contrast, when blood was recirculated with either ZK (0.003 microM) or PGE1 (0.3 microM), platelet counts were significantly preserved when compared to blood recirculated without drug (82 +/- 5% and 89 +/- 7%, respectively; P less than 0.01); mean platelet volume did not change; and dispersion only increased from 1.74 +/- 0.02 to 1.85 +/- 0.04 (P less than 0.05). However, following gel filtration, platelets recirculated with PGE1 always responded less than platelets merely incubated with PGE1 when challenged with either epinephrine (50 vs 75%, P less than 0.05) or thrombin (37 vs 65%, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
心肺转流期间广泛的血液-合成材料表面相互作用会导致不良的血小板改变，这可能会导致心脏直视手术后失血过多。通过暂时抑制血小板功能可减少这些血小板改变。为了进一步确定血液-合成材料表面接触期间血小板抑制的最佳方法，我们对在模拟体外循环（SEC）期间发生的血小板功能和结构改变进行了定量，尽管使用伊洛前列素（ZK）或前列腺素E1对血小板进行了抑制。500毫升新鲜肝素化人血在由硅橡胶部件和螺旋线圈膜式氧合器组成的回路中再循环2小时。当血液在无药物情况下再循环2小时时，血小板计数显著降至初始水平的46±7%（平均值±标准误）（P<0.01）；平均血小板体积从6.90±0.25立方微米降至6.05±0.33立方微米（P<0.01）；血小板离散度从1.73±0.02增加到2.14±0.09（P<0.01），并且血小板不再对肾上腺素或凝血酶产生聚集反应。相比之下，当血液与ZK（0.003微摩尔）或前列腺素E1（0.3微摩尔）一起再循环时，与无药物再循环的血液相比，血小板计数得到显著保留（分别为82±5%和89±7%；P<0.01）；平均血小板体积没有变化；离散度仅从1.74±0.02增加到1.85±0.04（P<0.05）。然而，在凝胶过滤后，用前列腺素E1再循环的血小板在受到肾上腺素（50%对75%，P<0.05）或凝血酶（37%对65%，P<0.05）刺激时，其反应总是比仅用前列腺素E1孵育的血小板弱。（摘要截断于250字）
