Point-of-Care Assessment of Hypothermia and Protamine-Induced Platelet Dysfunction with Multiple Electrode Aggregometry (Multiplate®) in Patients Undergoing Cardiopulmonary Bypass
Point-of-Care Assessment of Hypothermia and Protamine-Induced Platelet Dysfunction with Multiple Electrode Aggregometry (Multiplate®) in Patients Undergoing Cardiopulmonary Bypass
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DOI：
10.1213/ane.0b013e31827cee88
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发表时间：
2013-03-01
影响因子：
5.7
通讯作者：
Besser, Martin W.
中科院分区：
文献类型：
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作者：
Ortmann, Erik;Klein, Andrew A.;Besser, Martin W.
背景技术背景：凝血功能障碍在体外循环（CPB）后很常见，而血小板功能障碍通常被认为是过度出血的主要原因。低温暴露可加重血小板功能缺陷。我们用多电极聚集测定法（Multiplate（R）; Verum Diagnostica GmbH，慕尼黑，德国）在深低温期间和之后评估血小板功能。方法：20名因慢性肺动脉高压而接受肺动脉内膜切除术的成人患者在CPB中冷却至20 ℃，并使用深低温停搏来促进手术。我们分析了血小板聚集在全血样本中的12个测量点的过程中和之后。在患者的实际体温（AUC-CT）和将样品复温至37 ° C（AUC-37）后，通过凝血酶受体（TRAPtest）刺激血小板聚集。此外，我们用20 μ g鱼精蛋白（0.067 μ g/μ L）体外孵育2分钟后，在2个时间点检测了样品。结果：在20 ℃体温下，冷却导致血小板聚集显著降低至最小AUC-CT为20.5（95%置信区间[CI] 8.9-32.1）。AUC-CT与基线相比存在显著差异（92.8，95% CI 82.5-103.1），
BACKGROUND: Coagulopathy is common after cardiopulmonary bypass (CPB), and platelet dysfunction is frequently considered to be a major contributor to excessive bleeding. Exposure to hypothermia may exacerbate the platelet function defect. We assessed platelet function during and after deep hypothermia with multiple electrode aggregometry (Multiplate (R); Verum Diagnostica GmbH, Munich, Germany).METHODS: Twenty adult patients undergoing pulmonary endarterectomy for chronic pulmonary hypertension were cooled on CPB to 20 degrees C and deep hypothermic arrest was used to facilitate surgery. We analyzed platelet aggregation in whole blood samples at 12 measuring points during and after the procedure. Platelet aggregation was stimulated via the thrombin receptor (TRAPtest) at the patient's actual body temperature (AUC-CT) and after rewarming the samples to 37 degrees C (AUC-37). In addition, we tested samples at 2 time points after 2 minutes of in vitro incubation with 20 mu g protamine (0.067 mu g/mu L). Results are expressed as area under the aggregation curve (AUC).RESULTS: Cooling resulted in a marked decrease of platelet aggregation to a minimum AUC-CT of 20.5 (95% confidence interval [CI] 8.9-32.1) at 20 degrees C body temperature. AUC-CT was significantly different from baseline (92.8, 95% CI 82.5-103.1) for temperatures of