Agarwal S K, Ghosh P K, Gupta D
Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Ann Thorac Surg. 1995 Oct;60(4):1143-50. doi: 10.1016/0003-4975(95)00501-b.
Cold agglutinins are commonly found in sera of healthy persons. They rarely become clinically apparent due to their activity at low temperatures. In these patients, cardiovascular operations requiring hypothermia can result in complications such as hemolysis, renal failure, and myocardial damage and can cause unexpected morbidity and mortality. The literature on cold-reactive proteins is reviewed, and methods of diagnosis and management related to cardiac surgery are suggested. Ideally all patients should be routinely tested preoperatively for the antibodies, and appropriate changes in cardiopulmonary bypass and myocardial management plans should be made in positive patients. Preoperative plasmapheresis may be a useful adjunct, especially in patients requiring operation under profound hypothermia and circulatory arrest. Currently, warm heart surgery appears to be the most expedient method. Unexpected detection of agglutination during operation or hemolysis after operation requires a specific treatment plan.
冷凝集素常见于健康人的血清中。由于其在低温下才具有活性，所以临床上很少表现出明显症状。对于这些患者，需要低温的心血管手术可能会导致溶血、肾衰竭和心肌损伤等并发症，并可能引发意外的发病率和死亡率。本文回顾了关于冷反应蛋白的文献，并提出了与心脏手术相关的诊断和管理方法。理想情况下，所有患者术前都应常规检测抗体，抗体检测呈阳性的患者应适当调整体外循环和心肌管理方案。术前血浆置换可能是一种有用的辅助手段，尤其对于需要在深度低温和循环停止下进行手术的患者。目前，温心手术似乎是最便捷的方法。术中意外检测到凝集或术后发生溶血需要特定的治疗方案。
