Urlesberger B, Zobel G, Zenz W, Kuttnig-Haim M, Maurer U, Reiterer F, Riccabona M, Dacar D, Gallisti S, Leschnik B, Muntean W
Department of Neonatology, ECMO-Center, University of Graz, Austria.
J Pediatr. 1996 Aug;129(2):264-8. doi: 10.1016/s0022-3476(96)70252-4.
To determine the degree of clotting activation that occurs with the usual anticoagulation regimen with systemic heparinization.
To allow a standardized comparison of the patients, this study focused on the first 48 hours of extracorporeal membrane oxygenation (ECMO) in term newborn infants. The ECMO perfusion circuit consisted of a roller pump, silicone membrane lungs, and silicone rubber tubing. Coagulation was controlled routinely by measuring prothrombin time, fibrinogen, antithrombin III, and reptilase time. Platelet counts, activated clotting time, and heparin concentration were controlled regularly. The following specific activation markers of the clotting system were measured: prothrombin activation fragment 1 + 2(F1+2), thrombin-antithrombin III complexes, and D-dimer. Measurements were done before the start of ECMO, after 5 minutes, and at hours 1, 2, 3, 4, 6, 12, 24 and 48.
All seven term infants had excessively high levels of clotting activation markers within the first 2 hours of ECMO: F1+2, 11.6(+/- O.9) nmol/L (mean +/- SEM); thrombin-antithrombin, 920(+/- 2.2) microg/L; D-dimer, 15.522(+/- 3.689) ng/L. During the next 46 hours of ECMO, F1+2 and thrombin-antithrombin III complexes decreased from those high values, whereas D-dimer did not. The increase of activation markers was accompanied by low fibrinogen, low platelet counts. and prolongation of reptilase time.
These findings fit the pattern of consumptive coagulopathy during neonatal ECMO, especially in the first 24 hours.
确定全身肝素化的常规抗凝方案所引发的凝血激活程度。
为了对患者进行标准化比较，本研究聚焦于足月儿体外膜肺氧合（ECMO）治疗的最初48小时。ECMO灌注回路由一个滚压泵、硅酮膜肺和硅橡胶管组成。通过测量凝血酶原时间、纤维蛋白原、抗凝血酶III和蛇静脉酶时间来常规控制凝血情况。定期监测血小板计数、活化凝血时间和肝素浓度。测量以下凝血系统的特定激活标志物：凝血酶原激活片段1 + 2（F1+2）、凝血酶 - 抗凝血酶III复合物和D - 二聚体。在ECMO开始前、5分钟后以及第1、2、3、4、6、12、24和48小时进行测量。
所有7名足月儿在ECMO治疗的最初2小时内凝血激活标志物水平均过高：F1+2为11.6（±0.9）nmol/L（平均值±标准误）；凝血酶 - 抗凝血酶为920（±2.2）μg/L；D - 二聚体为15.522（±3.689）ng/L。在接下来的46小时ECMO治疗期间，F1+2和凝血酶 - 抗凝血酶III复合物从这些高值下降，而D - 二聚体没有。激活标志物的增加伴随着纤维蛋白原降低、血小板计数减少以及蛇静脉酶时间延长。
这些发现符合新生儿ECMO期间消耗性凝血病的模式，尤其是在最初24小时内。
