Does the additional use of heparin-coated extracorporeal circuits (ECC) optimize the effect of modified ultrafiltration (MUF) in pediatric perfusion?
Does the additional use of heparin-coated extracorporeal circuits (ECC) optimize the effect of modified ultrafiltration (MUF) in pediatric perfusion?
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DOI：
10.1055/s-2005-872863
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发表时间：
2006-04-01
影响因子：
1.5
通讯作者：
Cesnjevar, R.
中科院分区：
文献类型：
--
作者：
Harig, F.;Meier, C.;Cesnjevar, R.
背景：改良超滤（MUF）已被证明对儿童心脏手术体外循环（ECC）后的凝血系统和毛细血管泄漏有有益的影响。这项研究的目的是调查是否额外使用肝素包覆电路是一个有用的选择，以提高生物相容性。方法：我们随机选择28名儿童，A组（n = 14）使用肝素包被ECC电路，B组（n = 14）使用未包被ECC电路。先天性心脏手术后，以标准化的方式在ECC后进行MUF。术前、ECC后10 min、30 min、1 h和48 h采用流式细胞术（facc - sort）分析血液样本，采用表面抗原CD62/CD41b（血小板）和CD45/CD14（单核细胞）。结果：两组患者的平均年龄（20.6个月vs. 21.6个月）、平均体重（9.2 kg vs. 8.4 kg）、平均超滤率（9.1 ml/kg vs. 11.4 ml/kg）、胸管引流、血液制品、ICU住院时间和30 d生存率均无显著差异。A组CD62/ cd41阳性血小板百分比（与B组相比）在60 min时上升至118%，而在48 h时下降至98% （p < 0.05）。Vs. 99% （n.s.）。A组CD45/ cd14阳性单核细胞的百分比（与B组相比）在60 min时上升到158%，而在48 h时下降到122% （A组）。对比61% (B) （p < 0.05）。结论：肝素包被ECC和MUF导致血小板活化降低。单核细胞表面标志物CD45和CD14在两组患者的ECC过程中都有明显的激活，但额外的肝素涂层在后期过程中显示出更好的单核细胞标记的术后再生，表明有益的叠加效应。
Background: Modified Ultrafiltration (MUF) has been shown to exert beneficial effects on the coagulation system and the capillary leak after pediatric cardiac surgery using extracorporeal circulation (ECC). The aim of this study was to investigate whether the additional use of heparin-coated circuits is a useful option for improving biocompatibility. Methods: We randomized 28 children, using heparin-coated ECC circuits in group A (n = 14) and an uncoated equivalent set in group B (n = 14). After congenital heart surgery, MUF was performed post ECC in a standardized fashion. Blood samples were analyzed preoperatively, 10 min, 30 min, I h, and 48 h after ECC by flow cytometric analysis (FAC-Sort) using surface antigens CD62/CD41b (platelets) and CD45/CD14 (monocytes). Results: No significant difference was found with respect to mean age (20.6 months vs. 21.6 months), mean body weight (9.2 kg vs. 8.4 kg), mean ultrafiltration rate (9.1 ml/kg vs. 11.4 ml/kg), chest tube drainage, blood products, ICU stay, and 30-d survival. The percentage of CD62/CD41-positive platelets in group A (vs. B) increased up to 118% at 60 min vs. 130% (p < 0.05) and declined to 98% at 48 h postop. vs. 99% (n.s.). The percentage of CD45/CD14-positive monocytes in group A (vs. B) increased up to 158% at 60 min vs. 155% (n.s.) and declined to 122 % (A) at 48 h postop. vs. 61 % (B) (p > 0.05). Conclusions: Heparin coating of ECC in addition to MUF leads to a lower platelet activation. Monocyte surface markers CD45 and CD14 indicated a marked activation during ECC in both groups but additional heparin coating showed a better postoperative regeneration of monocyte markers in the late course indicating a beneficial additive effect.