Dewanjee M K, Wu S M, Kapadvanjwala M, De D, Dewanjee S, Gonzalez L, Novak S, Hsu L C, Perryman R A, Duncan R C, Serafini A N, Sfakianakis G N, Horton A F
Department of Radiology, University of Miami, School of Medicine, Florida, USA.
ASAIO J. 1996 Nov-Dec;42(6):1010-8. doi: 10.1097/00002480-199642060-00015.
The effect of an arterial filter on visceral emboli was quantified with autologous indium-111 labeled platelets (INPLT) during cardiopulmonary bypass (CPB) in Yorkshire pigs. Biodistribution of INPLT was determined in 12 control pigs (30-35 kg, unoperated control [n = 6] and sham operated control [n = 6]). CPB was carried out with (n = 6) and without (n = 6) an arterial filter in 12 pigs at a flow rate of 2.5-3.5 L/min. Platelets labeled with In-111 tropolone (650-780 microCi) were injected intravenously 24 hr before CPB. All pigs were systemically heparinized (activated coagulation time > 400 sec); CPB was instituted with a roller pump, an extraluminal blood flow oxygenator (Bentley Univox, 1.8 m2), and an arterial filter (0.25 m2) and continued for 3 hr. Platelet kinetics, pooling, and counts were monitored by a Geiger probe and a Coulter counter. The thrombi in the oxygenator and arterial filter and emboli in viscera and brain were imaged with a gamma camera and measured with an ion chamber and gamma counter. Percentage of INPLT (mean +/- SD) in organs, tissues, and components of the circuit in four groups of pigs was calculated. Flow cytometry with antibodies to CD61 (GPIIIa) and CD62P (GMP-140: control) of porcine platelets was carried out with blood samples taken before, during, and after CPB for estimation of circulating platelet aggregates and platelet microparticles. Pulmonary, renal, cardiac, and cerebral emboli in pigs undergoing CPB with and without a filter were similar (p < 0.1). The amount of filter adherent thrombi was small (0.04 +/- 0.01%); oxygenator adherent thrombus in both groups was similar (p < 0.1). Emboli were found in the cerebral medulla, hippocampus, and posterior cerebral cortex in both groups. During CPB, the arterial filter functioned minimally as a trap for platelet thrombi detached from the oxygenator and circulating emboli. Flow cytometry of blood demonstrated the shift of equilibria from single platelets to platelet aggregates and microparticles during CPB and their gradual reversal to single platelets after CPB; the loosely adherent emboli disaggregated and further shifted these equilibria to single platelets and smaller aggregates, probably through the action of endogenous nitric oxide and prostacyclin. The emboli were trapped in organs and tissues and microparticles were sequestered by the reticuloendothelial system.
在约克郡猪体外循环（CPB）期间，使用自体铟 - 111标记的血小板（INPLT）对动脉滤器对内脏栓子的影响进行了定量研究。在12只对照猪（30 - 35千克，未手术对照[n = 6]和假手术对照[n = 6]）中确定了INPLT的生物分布。12只猪在流量为2.5 - 3.5升/分钟的情况下进行体外循环，其中6只使用动脉滤器（n = 6），6只不使用动脉滤器（n = 6）。在体外循环前24小时静脉注射用铟 - 111托酚酮（650 - 780微居里）标记的血小板。所有猪均全身肝素化（活化凝血时间> 400秒）；体外循环采用滚压泵、腔外血流氧合器（Bentley Univox，1.8平方米）和动脉滤器（0.25平方米），持续3小时。通过盖革探头和库尔特计数器监测血小板动力学、聚集情况和计数。用γ相机对氧合器和动脉滤器中的血栓以及内脏和大脑中的栓子进行成像，并用离子室和γ计数器进行测量。计算了四组猪的器官、组织和循环回路组件中INPLT的百分比（平均值±标准差）。在体外循环前、期间和之后采集的血样中，使用针对猪血小板CD61（GPIIIa）和CD62P（GMP - 140：对照）的抗体进行流式细胞术，以评估循环血小板聚集体和血小板微粒。使用和不使用滤器进行体外循环的猪的肺、肾、心脏和脑栓子情况相似（p < 0.1）。滤器附着血栓的量很少（0.04±0.01%）；两组中氧合器附着血栓情况相似（p < 0.1）。两组均在脑髓质、海马体和大脑后皮质中发现栓子。在体外循环期间，动脉滤器作为捕获从氧合器分离的血小板血栓和循环栓子的作用微乎其微。血液流式细胞术表明，在体外循环期间，平衡从单个血小板向血小板聚集体和微粒转移，体外循环后逐渐恢复到单个血小板；松散附着的栓子解体，并可能通过内源性一氧化氮和前列环素的作用，使这些平衡进一步向单个血小板和较小聚集体转移。栓子被困在器官和组织中，微粒被网状内皮系统隔离。
