Himmelreich G, Hundt K, Neuhaus P, Bechstein W O, Roissant R, Riess H
Department of Internal Medicine, Universitätsklinikum Rudolf, Virchow, Berlin, Germany.
Transplantation. 1993 Apr;55(4):819-26. doi: 10.1097/00007890-199304000-00026.
Recent investigations measuring platelet aggregation during 10 orthotopic liver transplantations showed a significant decrease in platelet aggregation immediately after reperfusion and in the perfusate. As prostaglandin E1 has been shown to exhibit a beneficial effect in the treatment of ischemic injury of the liver, we investigated in a prospective, randomized, and open study the effect of PGE1 infusion during OLT on platelet function. Ten patients were randomized to receive a continuous PGE1 infusion (PG group) and another ten patients served as controls. Platelet function was determined ex vivo by measuring the adenosine diphosphate-, collagen-, and ristocetin-induced aggregation in platelet-rich plasma. A significantly higher platelet aggregability was measured in the PG group throughout the whole operation for ADP (1 and 2 mumol/L) and collagen (0.5 micrograms/ml). The same was true for collagen (1 microgram/ml) and ristocetin (1.2 mg/ml) after reperfusion. Not only the postreperfusional decrease in platelet aggregation but also the decline in platelet count that occurred in the control group could be prevented greatly by PGE1 infusion. In the perfusate, released from the liver graft vein by flushing with arterial blood, a significantly lower platelet aggregability was seen in comparison with the systemic circulation before reperfusion in the control group, a difference that was not found when PGE1 infusion was given intraoperatively. However, blood product requirements during OLT were comparable in both groups. In conclusion, PGE1 therapy during OLT preserves platelet function and prevents the drop in platelet count observed in the control group after revascularization.
近期对10例原位肝移植术中血小板聚集情况的研究表明，再灌注后即刻及灌注液中的血小板聚集显著减少。由于前列腺素E1已被证明在治疗肝脏缺血性损伤方面具有有益作用，我们在一项前瞻性、随机、开放性研究中，调查了原位肝移植术中输注前列腺素E1对血小板功能的影响。10例患者被随机分配接受持续前列腺素E1输注（PG组），另外10例患者作为对照组。通过测量富血小板血浆中由二磷酸腺苷、胶原和瑞斯托霉素诱导的聚集情况，对体外血小板功能进行测定。在整个手术过程中，PG组对于二磷酸腺苷（1和2μmol/L）和胶原（0.5μg/ml）的血小板聚集性显著更高。再灌注后对于胶原（1μg/ml）和瑞斯托霉素（1.2mg/ml）也是如此。前列腺素E1输注不仅能极大地预防对照组中再灌注后血小板聚集的下降，还能预防血小板计数的降低。在通过动脉血冲洗从肝移植静脉释放的灌注液中，与对照组再灌注前的体循环相比，血小板聚集性显著更低，而术中给予前列腺素E1输注时未发现这种差异。然而，两组原位肝移植术中血液制品的需求量相当。总之，原位肝移植术中前列腺素E1治疗可保留血小板功能，并防止对照组在血管再通后出现的血小板计数下降。
