Department of Cardiothoracic and Vascular Surgery and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Department of Clinical Chemistry and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Cardiovascular Research Centre, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
J Cardiothorac Vasc Anesth. 2023 Jul;37(7):1110-1120. doi: 10.1053/j.jvca.2023.03.013. Epub 2023 Mar 13.
Previous studies have described impaired platelet function after cardiopulmonary bypass (CPB). Whether this is still valid in contemporary cardiac surgery is unclear. This study aimed to quantify changes in function and number of platelets during CPB in a present-day cardiac surgery cohort.
Prospective, controlled clinical study.
A single-center university hospital.
Thirty-nine patients scheduled for coronary artery bypass graft surgery with CPB.
Platelet function and numbers were measured at 6 timepoints in 39 patients during and after coronary artery bypass graft surgery; at baseline before anesthesia, at the end of CPB, after protamine administration, at intensive care unit (ICU) arrival, 3 hours after ICU arrival, and on the morning after surgery.
Platelet function was assessed with impedance aggregometry and flow cytometry. Platelet numbers are expressed as actual concentration and as numbers corrected for dilution using hemoglobin as a reference marker. There was no consistent impairment of platelet function during CPB with either impedance aggregometry or flow cytometry. After protamine administration, a decrease in platelet function was seen with impedance aggregometry and for some markers of activation with flow cytometry. Platelet function was restored 3 hours after arrival in the ICU. During CPB (85.0 ± 21 min), the number of circulating platelets corrected for dilution increased from 1.73 ± 0.42 × 10/g to 1.91 ± 0.51 × 10/g (p < 0.001).
During cardiac surgery with moderate CPB times, platelet function was not impaired, and no consumption of circulating platelets could be detected. Administration of protamine transiently affected platelet function.
先前的研究已经描述了体外循环（CPB）后血小板功能受损。在当代心脏手术中，这种情况是否仍然存在还不清楚。本研究旨在定量评估当代心脏手术患者 CPB 期间和期间血小板功能和数量的变化。
前瞻性、对照的临床研究。
单中心大学医院。
39 例行 CPB 冠状动脉旁路移植术的患者。
在 39 例患者的冠状动脉旁路移植术中及术后 6 个时间点测量血小板功能和数量；麻醉前基础值、CPB 结束时、鱼精蛋白给药后、重症监护病房（ICU）到达时、ICU 到达后 3 小时和术后清晨。
使用阻抗聚集仪和流式细胞术评估血小板功能。血小板数量用实际浓度和用血红蛋白作为参考标记物校正稀释后的数量表示。无论是用阻抗聚集仪还是用流式细胞术，CPB 期间血小板功能均无一致的损害。鱼精蛋白给药后，阻抗聚集仪显示血小板功能下降，某些流式细胞术激活标志物也显示血小板功能下降。到达 ICU 3 小时后，血小板功能恢复。在 CPB 期间（85.0±21 分钟），校正稀释的循环血小板数从 1.73±0.42×10/g 增加到 1.91±0.51×10/g（p<0.001）。
在体外循环时间适中的心脏手术中，血小板功能未受损，也未检测到循环血小板的消耗。鱼精蛋白的给药会短暂影响血小板功能。
