Elevated pulmonary dead space and coagulation abnormalities suggest lung microvascular thrombosis in patients undergoing cardiac surgery
Elevated pulmonary dead space and coagulation abnormalities suggest lung microvascular thrombosis in patients undergoing cardiac surgery
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DOI：
10.1007/s00134-008-1042-7
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发表时间：
2008-07-01
影响因子：
38.9
通讯作者：
Santamaria, John D.
中科院分区：
文献类型：
--
作者：
Dixon, Barry;Campbell, Duncan J.;Santamaria, John D.
目的：炎症已被证明是微血管血栓形成的触发因素。接受心脏手术的患者会对肺部造成严重的炎症损伤，此外还常规给予抗纤维蛋白溶解剂以促进血栓形成。鉴于这些危险因素，我们研究了心脏手术后是否发生肺微血管血栓形成的证据，如果是，术前肝素输注是否可以限制这种情况。设计：双盲随机对照试验。单位：高校附属医院。患者：20例接受择期心脏手术的患者。干预：患者随机接受术前肝素输注或安慰剂。所有患者均给予抑肽酶。测量和结果：通过测量肺泡死腔分数来估计肺微血管阻塞。通过测量桡动脉和肺动脉血中凝血酶原片段水平的比率来估计肺凝血激活。还评估了全身组织纤溶酶原激活物（t-PA）水平。在安慰剂组中，心脏手术引发肺泡死腔分数水平增加和肺循环中凝血酶原片段产生的开始。术前应用肝素与肺泡死腔分数降低（p < 0.05）和肺循环中凝血酶原片段产生减少（p < 0.05）相关。术前肝素也增加了基线t-PA水平（p < 0.05）。结论：肺泡死腔分数和肺凝血激活的变化表明，肺微血管血栓形成的心脏手术过程中，这可能是有限的术前肝素输注。
Objective: Inflammation has been shown to trigger microvascular thrombosis. Patients undergoing cardiac surgery sustain significant inflammatory insults to the lungs and in addition are routinely given anti-fibrinolytic agents to promote thrombosis. In view of these risk factors we investigated if evidence of pulmonary microvascular thrombosis occurs following cardiac surgery and, if so, whether a pre-operative heparin infusion may limit this. Design: Double-blind randomised controlled trial. Setting: Tertiary university affiliated hospital. Patients: Twenty patients undergoing elective cardiac surgery. Interventions: Patients were randomised to receive a pre-operative heparin infusion or placebo. All patients were administered aprotinin. Measurements and results: Pulmonary microvascular obstruction was estimated by measuring the alveolar dead-space fraction. Pulmonary coagulation activation was estimated by measuring the ratio of prothrombin fragment levels in radial and pulmonary arterial blood. Systemic tissue plasminogen activator (t-PA) levels were also assessed. In the placebo group cardiac surgery triggered increased alveolar dead-space fraction levels and the onset of prothrombin fragment production in the pulmonary circulation. Administration of preoperative heparin was associated with a lower alveolar dead-space fraction (p < 0.05) and reduced prothrombin fragment production in the pulmonary circulation (p < 0.05). Pre-operative heparin also increased baseline t-PA levels (p < 0.05). Conclusion: The changes in the alveolar dead-space fraction and pulmonary coagulation activation suggest that pulmonary microvascular thrombosis develops during cardiac surgery and this may be limited by a pre-operative heparin infusion.