Olsson A, Alfredsson J, Thelander M, Svedjeholm R, Berglund J Sanmartin, Berg S
Department of Health Science, Blekinge Institute of Technology, Karlskrona, Sweden.
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Scand Cardiovasc J. 2019 Dec;53(6):355-360. doi: 10.1080/14017431.2019.1659396. Epub 2019 Sep 3.
Protamine reduces platelet aggregation after cardiopulmonary bypass (CPB). We studied the inhibitory effect of a reduced protamine dose, the duration of impaired platelet function and the possible correlation to postoperative bleeding. Platelet function was assessed by impedance aggregometry in 30 patients undergoing cardiac surgery with CPB at baseline, before protamine administration, after 70% and 100% of the calculated protamine dose, after 20 minutes and at arrival to the intensive care unit. Adenosine diphosphate (ADP), thrombin receptor activating peptide-6 (TRAP), arachidonic acid (AA) and collagen (COL) were used as activators. Blood loss was measured during operation and three hours after surgery. Results are presented as median (25th-75th percentile). Platelet aggregation decreased markedly after the initial dose of protamine (70%) with all activators; ADP 89 (71-110) to 54 (35-78), TRAP 143 (116-167) to 109 (77-136), both < .01; AA 25 (16-49) to 17 (12-24) and COL 92 (47-103) to 60 (38-81) U, both < .05. No further decrease was seen after 100% protamine. The effect was transient and after twenty minutes platelet aggregation had started to recover; ADP 76 (54-106), TRAP 138 (95-158), AA 20 (10-35), COL 70 (51-93) U. Blood loss during operation correlated to aggregometry measured at baseline and after protaminization. Protamine after CPB induces a marked decrease in platelet aggregation already at a protamine-heparin ratio of 0.7:1. The impairment seems to be transient and recovery had started after 20 minutes.
鱼精蛋白可降低体外循环（CPB）后的血小板聚集。我们研究了降低鱼精蛋白剂量的抑制作用、血小板功能受损的持续时间以及与术后出血的可能相关性。通过阻抗聚集法对30例接受CPB心脏手术的患者在基线、给予鱼精蛋白前、给予计算剂量的70%和100%鱼精蛋白后、20分钟后以及到达重症监护病房时的血小板功能进行评估。使用二磷酸腺苷（ADP）、凝血酶受体激活肽-6（TRAP）、花生四烯酸（AA）和胶原（COL）作为激活剂。在手术期间和术后三小时测量失血量。结果以中位数（第25-75百分位数）表示。给予初始剂量的鱼精蛋白（70%）后，所有激活剂导致血小板聚集均显著下降；ADP从89（71-110）降至54（35-78），TRAP从143（116-167）降至109（77-136），两者均P<0.01；AA从25（16-49）降至17（12-24），COL从92（47-103）降至60（38-81）U，两者均P<0.05。给予100%鱼精蛋白后未见进一步下降。这种作用是短暂的，20分钟后血小板聚集开始恢复；ADP为76（54-106），TRAP为138（95-158），AA为20（10-35），COL为70（51-93）U。手术期间的失血量与基线时和给予鱼精蛋白后的聚集法测量结果相关。CPB后鱼精蛋白在鱼精蛋白-肝素比为0.7:1时即可显著降低血小板聚集。这种损害似乎是短暂的，20分钟后已开始恢复。
