Dewanjee M K, Wu S M, Kapadvanjwala M, Hsu L C
Department of Veterinary Biosciences, University of Illinois at Champaign-Urbana, Urbana 61802-8511, USA.
ASAIO J. 1998 Sep-Oct;44(5):M374-9. doi: 10.1097/00002480-199809000-00009.
The pool of thrombin and fibrinogen in circulation, in organs, and on cardiopulmonary bypass devices was quantified during and after cardiopulmonary bypass in four groups of 24 Yorkshire pigs (weight, 30-35 kg); two groups of 10 unoperated pigs were used as controls. Thrombin-alpha and fibrinogen were iodinated with 125iodide using an iodogen transfer technique; 250-300 microCi of these tracers were injected intravenously 1 hr before cardiopulmonary bypass. All pigs were systematically heparinized (activated clotting time > 400 sec); cardiopulmonary bypass was performed at 2.5-3.5 L/min at 28 degrees C using a centrifugal pump, oxygenator (Bentley Univox 1.8 m2; Bentley Inc., Irvine, CA), arterial filter (0.25 m2), and cardiotomy reservoir (BMR 3500) for 90 min, followed by a 90 min reperfusion and 180 min of cardiopulmonary bypass. Iodinated thrombin-alpha and fibrinogen in intact organs and samples of blood, organs, tissues, and oxygenator-arterial filter-cardiotomy reservoir were quantified with an ion chamber and a gamma counter, respectively. The percent of injected iodinated thrombin-alpha and fibrinogen dose (mean +/- SD) in organs and cardiopulmonary bypass devices of all groups of cardiopulmonary bypass pigs was calculated. Thrombin generated at the small area of surgical wounds (0.016-0.038 m2), and fibrin deposited on surfaces of cardiopulmonary bypass devices (2.59 m2), initiate and propagate thrombus formation and embolization. The protein level reached saturation values on all cardiopulmonary bypass devices at 180 min. High levels of thrombin and fibrinogen-fibrin circulate in blood and organs, and are adsorbed on cardiopulmonary bypass devices; this large blood pool of pro-coagulants in the cardiac cradle, tissues, and perfused organs may account for thrombi and emboli during and after cardiopulmonary bypass.
在四组24头约克夏猪（体重30 - 35千克）进行体外循环期间及之后，对循环系统、器官以及体外循环装置中的凝血酶和纤维蛋白原含量进行了定量分析；两组各10头未手术的猪作为对照。采用碘标记转移技术用125碘对凝血酶-α和纤维蛋白原进行碘化；在体外循环前1小时静脉注射250 - 300微居里的这些示踪剂。所有猪均进行系统性肝素化（活化凝血时间>400秒）；使用离心泵、氧合器（Bentley Univox 1.8平方米；Bentley公司，加利福尼亚州欧文市）、动脉滤器（0.25平方米）和心脏切开储血器（BMR 3500）在28摄氏度下以2.5 - 3.5升/分钟的流量进行90分钟的体外循环，随后进行90分钟的再灌注和180分钟的体外循环。分别用离子室和γ计数器对完整器官以及血液、器官、组织和氧合器 - 动脉滤器 - 心脏切开储血器样本中的碘化凝血酶-α和纤维蛋白原进行定量。计算所有体外循环猪组器官和体外循环装置中注入的碘化凝血酶-α和纤维蛋白原剂量的百分比（平均值±标准差）。手术伤口小面积（0.016 - 0.038平方米）处产生的凝血酶以及体外循环装置表面（2.59平方米）沉积的纤维蛋白引发并促进血栓形成和栓塞。在180分钟时，所有体外循环装置上的蛋白质水平达到饱和值。高水平的凝血酶和纤维蛋白原 - 纤维蛋白在血液和器官中循环，并吸附在体外循环装置上；心脏支架、组织和灌注器官中这种大量的促凝剂血池可能是体外循环期间及之后血栓和栓子形成的原因。
