Bockeria Leo A, Samsonova Natalia N, Yurlov Ivan A, Klimovich Ludmila G, Kozar Elena F, Olsen Eva H N, Zaets Sergey B
Bakoulev Center for Cardiovascular Surgery, Moscow, Russia.
Pediatr Cardiol. 2014 Oct;35(7):1108-15. doi: 10.1007/s00246-014-0903-9. Epub 2014 Apr 9.
Cardiopulmonary bypass (CPB) reduces coagulation factor levels through hemodilution and consumption. Differences in CPB-induced alterations of factor XIII (FXIII) levels in children with cyanotic and acyanotic congenital heart defects (CHDs) are not well characterized. FXIII activity (determined by Berichrom assay), prothrombin index, activated partial thromboplastin time, and fibrinogen were measured before open heart surgery with CPB and 5 days postoperatively for children older than 3 years with acyanotic (n = 30) and cyanotic (n = 30) CHDs. The preoperative FXIII levels did not differ significantly among the children of the compared groups. The cyanotic patients showed a significantly longer duration of CPB (111.4 ± 45.8 vs 71.5 ± 33.6 min; p = 0.026) and aortic cross-clamp (68.0 ± 27.1 vs 45.4 ± 31.4 min; p = 0.034). The drop in FXIII levels after termination of CPB was more profound for the children with cyanotic CHDs (87.1 ± 13.4 to 49.1 ± 13.2 vs 81.5 ± 12.6 to 58.6 ± 11.1 %, respectively; p = 0.018). The cyanotc patients also were restored to their baseline FXIII levels later than the children with acyanotic CHDs (at 48 vs 24 h). The post-CPB dynamics of the majority of the other coagulation parameters in the compared groups of patients were similar. The cyanotic patients experienced significantly greater postoperative blood loss than the acyanotic patients (12.6 ± 4.9 vs 5.0 ± 2.1 mL/kg; p < 0.001) and were transfused with larger volumes of red blood cells (10.4 ± 6.5 vs 4.2 ± 2.5 mL/kg; p = 0.007). The decrease in FXIII levels after CPB is more profound and lasts longer in children with cyanotic CHDs than in acyanotic patients. The rational strategy of postoperative FXIII replacement therapy for these categories of patients needs to be determined.
体外循环（CPB）通过血液稀释和消耗降低凝血因子水平。对于患有青紫型和非青紫型先天性心脏病（CHD）的儿童，CPB引起的凝血因子 XIII（FXIII）水平变化的差异尚未得到充分描述。对年龄大于3岁的非青紫型（n = 30）和青紫型（n = 30）CHD患儿，在CPB心脏直视手术前及术后5天测量FXIII活性（通过Berichrom测定法）、凝血酶原指数、活化部分凝血活酶时间和纤维蛋白原。比较组患儿术前FXIII水平无显著差异。青紫型患者的CPB持续时间显著更长（111.4±45.8 vs 71.5±33.6分钟；p = 0.026），主动脉阻断时间也更长（68.0±27.1 vs 45.4±31.4分钟；p = 0.034）。CPB结束后，青紫型CHD患儿的FXIII水平下降更为显著（分别从87.1±13.4降至49.1±13.2 vs从81.5±12.6降至58.6±11.1%；p = 0.018）。青紫型患者恢复至基线FXIII水平的时间也比非青紫型CHD患儿晚（分别为48小时和24小时）。比较组患者中大多数其他凝血参数的CPB后动态变化相似。青紫型患者术后失血量显著多于非青紫型患者（12.6±4.9 vs 5.0±2.1 mL/kg；p < 0.001），输注的红细胞量也更多（10.4±6.5 vs 4.2±2.5 mL/kg；p = 0.007）。与非青紫型患者相比，CPB后青紫型CHD患儿的FXIII水平下降更显著且持续时间更长。需要确定针对这些类型患者的术后FXIII替代治疗的合理策略。
