体外循环期间选定的血液凝固参数。

Selected blood coagulation parameters during extracorporeal circulation.

作者信息

Schoeffel D, Schimpf K, Krier C

出版信息

Behring Inst Mitt. 1986 Feb(79):104-11.

Abstract

We investigated selected coagulation parameters in 13 patients who had undergone open heart surgery with extracorporeal circulation (ECC). During ECC factor XIIa increased considerably to 38%. This may lead to intravascular coagulation, which is however inhibited during ECC by the administered heparin. The C1-inhibitor activity decreased to 12% during ECC, this decrease was considerably greater and lasted longer than the decrease of the C1-inhibitor concentration, which declined to 59%. The levels of the other coagulation factors I, II, V, VII, X, XII, antithrombin III, alpha 2-antiplasmin and platelets decreased to 50-60%. The latter was predominantly due to hemodilution at the beginning of ECC. We assume that the critical period for the coagulation system in ECC appears when ECC is discontinued. At this point we have a high factor XIIa level and a low C1-inhibitor activity so that intravascular coagulation (DIC) may occur because then the inhibitory effect of heparin is neutralized by protamine.

摘要

我们对13例接受体外循环（ECC）心脏直视手术的患者的特定凝血参数进行了研究。在ECC期间，因子XIIa大幅增加至38%。这可能导致血管内凝血，不过在ECC期间，所给予的肝素会抑制这种情况。ECC期间，C1抑制物活性降至12%，这种下降比C1抑制物浓度的下降幅度大得多且持续时间更长，C1抑制物浓度降至59%。其他凝血因子I、II、V、VII、X、XII、抗凝血酶III、α2 - 抗纤溶酶和血小板的水平降至50 - 60%。后者主要是由于ECC开始时的血液稀释。我们认为，ECC中凝血系统的关键时期出现在ECC停止时。此时，我们有较高的因子XIIa水平和较低的C1抑制物活性，因此可能会发生血管内凝血（弥散性血管内凝血），因为那时肝素的抑制作用会被鱼精蛋白中和。