Tissue factor as the main activator of the coagulation system during cardiopulmonary bypass
Tissue factor as the main activator of the coagulation system during cardiopulmonary bypass
复制标题
DOI：
10.1067/mtc.2002.120334
复制
发表时间：
2002-05-01
影响因子：
6
通讯作者：
Van Nooten, G
中科院分区：
文献类型：
--
作者：
De Somer, F;Van Belleghem, Y;Van Nooten, G
目的：本研究探讨了异物和血液从非血管结构上的凝血，溶血，和bloodloss.Methods的激活抽吸的影响：该系列包括3个随机组（组C，S，和S+P）的10例患者接受常规冠状动脉旁路移植术与体外循环。C组为对照组，所有抽吸血液均返回循环。S组弃去抽吸血液，S+P组与S组相同，表面涂有磷酸胆碱。测定血浆β-血小板球蛋白、凝血酶生成、结合珠蛋白和游离血红蛋白的浓度以及失血量。结果：C组游离血红蛋白稳定增加，凝血酶生成增加。此外，观察到凝血酶的产生与其抑制（凝血酶-抗凝血酶复合物）之间的密切相关性（r = 0.916）。C组血小板明显活化，S组活化程度较轻。相比之下，S+P组中的血小板活化可以忽略不计，导致30%，减少失血量（P = .05）。结论：组织接触污染的抽吸血液是凝血系统的最重要的激活剂，也是体外循环期间溶血的主要原因。与异物表面接触不是旁路促凝作用的主要变量。模仿外细胞膜结构导致血小板活化减少和失血减少。
Objective: This study investigates the influence of foreign material and blood aspirated from nonvascular structures on activation of coagulation, hemolysis, and blood loss.Methods: The series comprises 3 randomized groups (groups C, S, and S+P) of 10 patients undergoing routine coronary artery bypass grafting with cardiopulmonary bypass. In group C, the control group, all aspirated blood was returned into the circulation. In group S suction blood was discarded, whereas group S+P was identical to group S, with surfaces coated with phosphorylcholine. Plasma concentrations of beta-thromboglobulin, thrombin generation, haptoglobin, and free hemoglobin, as well as blood loss, were measured.Results: A steady increase in free plasma hemoglobin, as well as an increased generation of thrombin, was noticed in group C. Moreover, a close correlation (r = 0.916) between the generation of thrombin and its inhibition (thrombin-antithrombin complexes) was observed. Platelets were clearly activated in group C and, to a lesser extent, in group S. In contrast, platelet activation in group S+P was negligible, resulting in a 30%, decrease in blood loss (P = .05).Conclusions: Aspirated blood contaminated by tissue contact is the most important activator of the coagulation system and the principal cause of hemolysis during cardiopulmonary bypass. Contact with a foreign surface is not a main variable in the procoagulant effect of bypass. Mimicking the outer cell membrane structure resulted in decreased platelet activation and decreased blood loss.