摘要
背景本研究分别采用全血阻抗法与传统透光聚集度（LTA）测定血小板聚集率，以探讨抗血小板治疗药物是否会降低心脏手术或体外循环（CPB）后的血小板聚集功能。方法选择70例拟行择期冠状动脉旁路移植术的患者，分别于麻醉诱导前、诱导中和肝素化后15分钟及3小时采取动脉血，应用Multiplate（M）测定随时间变化的电阻值作为聚集单位，同时使用以胶原（COL）、二磷酸腺苷（ADP）或花生四烯酸（AA）为激活剂的LTA（％聚集率）法进行检测。A组（n=48）为对照组，手术前停用抗血小板药物至少7天，B组（n=11）和C组（n=11）患者分别服用阿司匹林100mg／d或阿司匹林100mg／d与氯吡格雷75mg／d（双重抗血小板治疗）至手术前一天。结果未行抗血小板治疗的患者，给予鱼精蛋白15分钟及3小时后，应用3种激活剂及两种聚集方法均可观察到血小板聚集率明显降低。单纯使用阿司匹林的患者，LTA—COL、LTA—ADP及M—ADP随时间发生显著改变；接受双重抗血小板治疗的患者，两种方法的ADP检测均提示给予鱼精蛋白15分钟后血小板聚集显著减弱。通过计算受试者工作特征曲线（receiver-operatingcharacteristiccurves，ROC曲线）下面积来区分抗血小板药物，LTA-COL可以在CPB后15分钟和3小时区分出对照组与阿司匹林组或双重抗血小板治疗组，M—ADP则可在鱼精蛋白拮抗后3小时区分对照组和双重抗血小板治疗组。结论对于未经抗血小板治疗的患者，全血电阻抗法及使用了常用激活剂的传统LTA法均可检测出CPB所致的血小板聚集功能改变。而对于接受了抗血小板治疗的患者，ADP激活的抗血小板检测方法能更好地检测出CPB所致的血小板聚集功能减退。
BACKGROUND： In this study, we explored whether antiplatelet medications impair whole blood impedance aggregometry after cardiac surgery and cardiopulmonary bypass （CPB） compared with dassical light transmission aggregometry （LTA）. METHODS： Multiplate （M） assays measuring changes in electrical resistance as aggregation units over time, and LTAassays （% aggregation） induced by collagen （COL）, adenosine diphosphate （ADP）, or arachidonic acid were performed simultaneously using arterial blood samples obtained before induction of anesthesia, 15 min and 3 h after neutralization of heparin in 70 consecutive patients scheduled for elective coronary artery bypass grafting. Patients in Group A （n= 48） discontinued intake of antiplatelet drugs for at least 7 days and served as controls, patients in Group B （n = 11 ） received aspirin 100 mg/d and those in Group C （n = 11 ） aspirin 100 mg/d and clopidogre175 mg/d （ dual antiplatelet therapy） until the day before surgery. RESULTS; In patients without antiplatelet therapy, 15 rain and 3 h after protamine a significant decrease in platelet aggregation was observed with all three agonists and both aggregation methods. In patients receiving aspirin alone, LTA-COL, LTA-ADP and M-ADP changed significantly over time, and ADP assays of both aggregation methods showed a significant decrease in platelet aggregation 15 min after protamine in patients receiving dual antiplatelet therapy. When calculating the areas under the receiver-operating characteristic curves for discrimination of antiplatelet agents, LTA-COL was able to discriminate between controls and patients receiving aspirin or dual antiplatelet therapy 15 min and 3 h after CPB and the M-ADP assay was able to discriminate between controls and patients receiving dual antiplatelet therapy 3 h after protamine. CONCLUSIONS： Whole blood and classical LTA performed with all commonly used agonists enable detection of CPB-induced changes jn platelet aggregation in patients not taking antiplatelet medication, whereas in patients receiving antiplatelet therapy, ADP-induced antiplatelet assays are preferable for detecting CPB-induced impairment of platelet aggregation.
出处
《麻醉与镇痛》
2011年第3期48-56,共9页
Anesthesia & Analgesia
