EFFECTS OF PROTAMINE ADMINISTRATION AFTER CARDIOPULMONARY BYPASS ON COMPLEMENT, BLOOD-ELEMENTS, AND THE HEMODYNAMIC STATE
EFFECTS OF PROTAMINE ADMINISTRATION AFTER CARDIOPULMONARY BYPASS ON COMPLEMENT, BLOOD-ELEMENTS, AND THE HEMODYNAMIC STATE
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DOI：
10.1016/s0003-4975(10)62668-9
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发表时间：
1986-02-01
影响因子：
4.6
通讯作者：
SAMUELSON, PN
中科院分区：
文献类型：
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作者：
KIRKLIN, JK;CHENOWETH, DE;SAMUELSON, PN
前瞻性地选择了 19 名患者，并在体外循环 (CPB) 后施用硫酸鱼精蛋白之前和之后进行了研究。给予鱼精蛋白后，C3a、C4a和C4d升高； C3a和C4a的峰值水平是在鱼精蛋白施用后10分钟采集的样品中，而C4d的峰值水平是在5小时后采集的样品中。 CPB 后和鱼精蛋白给药前仅 C3a 升高。在体外，只有硫酸鱼精蛋白和肝素的组合（而不是单独使用）才会导致 C3a 和 C4a 增加。鱼精蛋白的施用与血细胞、粒细胞和血小板总数的小幅和短暂的降低有关，并且与全身动脉和肺动脉以及左心房和右心房压力的小幅和短暂的降低有关。全身血管阻力下降（p = 0.07），肺血管阻力上升，但这种变化可能是偶然的（p = 0.29）。这些数据和其他人报道的数据支持这样的推论：补体激活在体外循环期间通过替代途径发生，并且在鱼精蛋白施用期间通过经典途径再次发生；这伴随着血细胞和血流动力学变化的全身炎症反应，当极端时，可能导致严重的血流动力学紊乱。
Nineteen patients were prospectively selected and studied before and after the administration of protamine sulfate following cardiopulmonary bypass (CPB). After protamine administration, C3a, C4a, and C4d were elevated; the peak levels of C3a and C4a were in samples taken 10 minutes after protamine administration while those of C4d were in those obtained at 5 hours. Only C3a was elevated after CPB and before protamine administration. In vitro, only the combination of protamine sulfate and heparin, and neither alone, resulted in increased C3a and C4a. Administration of protamine was associated with small and transient decreases in total while blood cells, granulocytes, and platelets, and with small and transient reductions in systemic and pulmonary arterial and left and right atrial pressures. Systemic vascular resistance fell (p = 0.07), and pulmonary vascular resistance rose but the change could be due to chance (p = 0.29). These data and those reported by others support the inference that complement activation occurs during CPB by the alternative pathway and again during protamine administration by the classic pathway; and that this accompanies a whole-body inflammatory reaction with blood cell and hemodynamic changes which, when extreme, could result in a severe hemodynamic derangement.