Mellgren K, Friberg L G, Mellgren G, Hedner T, Wennmalm A, Wadenvik H
Department of Pediatric Surgery, Ostra Hospital, Göteborg University, Sweden.
Ann Thorac Surg. 1996 Apr;61(4):1194-8. doi: 10.1016/0003-4975(96)00017-3.
Hemorrhage is a major complication experienced in 10% to 35% of neonates treated with extracorporeal life support (ECLS). The increased bleeding tendency is partly due to an ECLS-induced thrombocytopenia and impaired platelet function. In the present study, we evaluated the effect of nitric oxide on the ECLS-induced platelet consumption and activation.
Two identical in vitro ECLS circuits were primed with fresh, heparin-treated human blood and circulated for 24 hours. Nitric oxide (15, 40, or 77 ppm) was added to one of the oxygenators in each pair. Eight paired experiments were performed. Platelet count, plasma beta-thromboglobulin, platelet serotonin content, plasma nitrate, plasma cyclic guanosine monophosphate, and platelet membrane glycoprotein Ib were assayed before the start and at 0.5, 1, 3, 12, and 24 hours of perfusion.
Plasma nitrate and plasma cyclic guanosine monophosphate levels were significantly higher in the nitric oxide circuits than in the control circuits (p < 0.01). Higher platelet counts (p < 0.01) and lower beta-thromboglobulin levels (p < 0.01) were observed in the nitric oxide circuits compared with the control circuits. However, no significant differences in platelet serotonin content or platelet membrane glycoprotein Ib density were noted between the circuits.
Nitric oxide probably reduces platelet consumption and platelet activation during ECLS.
出血是接受体外生命支持（ECLS）治疗的新生儿中10%至35%会出现的主要并发症。出血倾向增加部分归因于ECLS诱导的血小板减少和血小板功能受损。在本研究中，我们评估了一氧化氮对ECLS诱导的血小板消耗和激活的影响。
两个相同的体外ECLS回路用新鲜的、肝素处理过的人血预充，并循环24小时。在每对回路的其中一个氧合器中加入一氧化氮（15、40或77 ppm）。进行了八对实验。在灌注开始前以及灌注0.5、1、3、12和24小时时检测血小板计数、血浆β-血小板球蛋白、血小板5-羟色胺含量、血浆硝酸盐、血浆环磷酸鸟苷以及血小板膜糖蛋白Ib。
一氧化氮回路中的血浆硝酸盐和血浆环磷酸鸟苷水平显著高于对照回路（p < 0.01）。与对照回路相比，一氧化氮回路中观察到更高的血小板计数（p < 0.01）和更低的β-血小板球蛋白水平（p < 0.01）。然而，各回路之间在血小板5-羟色胺含量或血小板膜糖蛋白Ib密度方面未发现显著差异。
一氧化氮可能会减少ECLS期间的血小板消耗和血小板激活。
