Ichinose F, Uezono S, Muto R, Uchida H, Hatori F, Terui K, Niimi Y, Goto T, Nakata Y, Morita S
Department of Anesthesia, Teikyo University Ichihara Hospital, Ichihara, Chiba, Japan.
Anesth Analg. 1999 Feb;88(2):258-62. doi: 10.1097/00000539-199902000-00006.
Platelet dysfunction is one of the most important factors contributing to a postoperative hemorrhagic diathesis in children with congenital heart disease undergoing operations requiring cardiopulmonary bypass (CPB). However, very little is known about the influence of CPB on platelets in neonates and young infants. We studied 16 patients--8 young infants (<2 mo old) and 8 children (>12 mo old)--with congenital heart disease undergoing CPB. Surface density of an important platelet adhesive receptor, glycoprotein Ib, and degree of platelet activation, indicated by p-selectin positivity, were measured by whole blood flow cytometry in samples obtained at seven time points during the operations. We found that the percentage of p-selectin-positive platelets increased significantly in children, but not in young infants, during CPB. The young infant group exhibited a significantly smaller reduction of glycoprotein Ib than the child group during CPB (21.0% +/- 12.0% vs 32.7% +/- 18.1%; P < 0.05). Lack of CPB-induced increase of p-selectin and a smaller decrease of glycoprotein Ib in young infants in the current study suggest reduced platelet reactivity in young infants and neonates during CPB. The clinical significance of the reduced platelet reactivity in young infants and neonates remains to be determined.
Platelets of young infants are less reactive than those of children during cardiopulmonary bypass, as determined by the cardiopulmonary bypass-induced alterations in platelet membrane adhesive receptors.
血小板功能障碍是导致接受需要体外循环（CPB）手术的先天性心脏病患儿术后出血素质的最重要因素之一。然而，关于CPB对新生儿和幼儿血小板的影响却知之甚少。我们研究了16例接受CPB的先天性心脏病患者，其中8例为幼儿（<2个月大），8例为儿童（>12个月大）。在手术期间的七个时间点采集的样本中，通过全血流式细胞术测量了一种重要的血小板黏附受体糖蛋白Ib的表面密度以及由p-选择素阳性表示的血小板活化程度。我们发现，在CPB期间，儿童中p-选择素阳性血小板的百分比显著增加，而幼儿中则未增加。在CPB期间，幼儿组糖蛋白Ib的减少幅度明显小于儿童组（21.0%±12.0%对32.7%±18.1%；P<0.05）。本研究中幼儿缺乏CPB诱导的p-选择素增加以及糖蛋白Ib减少幅度较小，提示幼儿和新生儿在CPB期间血小板反应性降低。幼儿和新生儿血小板反应性降低的临床意义仍有待确定。
通过体外循环诱导的血小板膜黏附受体改变确定，在体外循环期间，幼儿的血小板反应性低于儿童。
