Curtis J J, Wagner-Mann C C, Mann F A, Demmy T L, Walls J T, Schmaltz R A
Department of Surgery, School of Medicine, College of Veterinary Medicine, University of Missouri, Columbia, USA.
ASAIO J. 1997 Sep-Oct;43(5):M414-7.
An in vitro comparison of centrifugal pumping systems manufactured by Sarns-3M and St. Jude Medical revealed a difference in blood cell derangement. The purpose of this study was to compare in vivo the effects of 96 hr of left ventricular assist (LVA) on indexes of coagulopathy, hemolysis, and complement activation. Two groups of calves (each: n = 5) were instrumented with identical left atrial to thoracic aorta centrifugal pumping circuits using either Sarns-3M or St. Jude centrifugal pumps. Laboratory evaluations were performed pre-assist and at 1, 4, 24, 48, 72, and 96 hr during LVA. Platelet counts dropped significantly by 24 hr (Sarns-3M: 28%; St. Jude: 30%); no significant change in function was noted. Activated clotting time increased slightly (p > 0.05). Prothrombin time increased at 4 and 24 hr of LVA, returning to baseline by 96 hr (p < 0.05). Activated partial thromboplastin time increased with the St. Jude device from 24 to 96 hr on LVA (p < 0.05); the increase with the Sarns-3M device never reached significance. No significant changes in lactate dehydrogenase or plasma free hemoglobin were detected. Complement fraction C5a rose by 1 hr of LVA (p < 0.05), peaking at 4 hr and returning to baseline by 96 hr with both pumps. No significant difference was detected between pump groups for any of the parameters. It was concluded that 1) 96 hr Sarns-3M and St. Jude LVA caused coagulation derangement in calves, 2) neither pump demonstrated an advantage regarding coagulation and complement parameters, 3) hemolysis observed with the Sarns-3M pump in vitro was not evidenced in vivo, and 4) in vitro evidenced centrifugal pump differences may not be realized in vivo.
对Sarns - 3M公司和圣犹达医疗公司生产的离心式泵血系统进行的体外比较显示，血细胞紊乱存在差异。本研究的目的是在体内比较96小时左心室辅助（LVA）对凝血障碍、溶血和补体激活指标的影响。两组小牛（每组n = 5）使用Sarns - 3M或圣犹达离心式泵，安装相同的从左心房到胸主动脉的离心式泵血回路。在辅助前以及左心室辅助期间的1、4、24、48、72和96小时进行实验室评估。血小板计数在24小时时显著下降（Sarns - 3M：28%；圣犹达：30%）；未观察到功能有显著变化。活化凝血时间略有增加（p > 0.05）。左心室辅助4小时和24小时时凝血酶原时间增加，到96小时时恢复到基线水平（p < 0.05）。使用圣犹达设备时，左心室辅助24小时至96小时期间活化部分凝血活酶时间增加（p < 0.05）；使用Sarns - 3M设备时的增加未达到显著水平。未检测到乳酸脱氢酶或血浆游离血红蛋白有显著变化。补体C5a在左心室辅助1小时时升高（p < 0.05），4小时时达到峰值，两种泵在96小时时均恢复到基线水平。在任何参数方面，泵组之间均未检测到显著差异。得出的结论是：1）96小时的Sarns - 3M和圣犹达左心室辅助导致小牛出现凝血紊乱；2）两种泵在凝血和补体参数方面均未显示出优势；3）体外观察到的Sarns - 3M泵的溶血现象在体内未得到证实；4）体外显示的离心泵差异在体内可能无法体现。
