Platelet dysfunction after cardiopulmonary bypass (CPB) can contribute to excessive post-operative bleeding. Most trials of the protective effect of aprotinin in this setting have involved hypothermic CPB, which is more deleterious for platelets than normothermic CPB. Here we investigated the effect of aprotinin on platelet function during normothermic CPB in pediatric patients. Twenty patients (9 newborns [<1 month old] and 11 infants [<36 month old]), weighting less than 15 kg and undergoing normothermic CPB (35-36 degrees C) were randomly assigned to two equal groups, one of which received high-dose aprotinin. Platelet function was assessed by flow cytometry just before CPB and 5 minutes after heparin neutralization. F1 + 2 fragments were measured by ELISA before and 5 minutes after CPB. Platelet activation marker expression (CD62P and activated alphaIIbbeta3) induced by ADP or TRAP was lower after CPB than before CPB, suggesting a deleterious effect of normothermic CPB on platelet function. Prothrombin fragment F1 + 2 levels increased after CPB. Aprotinin administration did not influence the level of prothrombin fragments or platelet marker expression measured in basal condition. However, after CPB, the capacity for platelet activation was higher in the aprotinin group, as shown by measuring CD62P expression after TRAP activation (p = 0.05). This study suggests that pediatric normothermic CPB causes platelet dysfunction, and that high-dose aprotinin has a protective effect.

译文

体外循环 (CPB) 后的血小板功能障碍可导致术后出血过多。在这种情况下,大多数有关抑肽酶保护作用的试验都涉及低温CPB,这对血小板比常温CPB更有害。在这里,我们研究了抑肽酶对儿童患者常温CPB期间血小板功能的影响。20名患者 (9名新生儿 [<1个月大] 和11名婴儿 [<36个月大]),体重小于15千克并接受常温CPB (35-36摄氏度),被随机分配到两个相等的组,其中一个接受高剂量抑肽酶。在CPB之前和肝素中和后5分钟通过流式细胞术评估血小板功能。在CPB之前和之后5分钟通过ELISA测量F1 2片段。CPB后ADP或TRAP诱导的血小板活化标志物表达 (CD62P和活化的alphaIIbbeta3) 低于CPB之前,表明常温CPB对血小板功能具有有害作用。CPB后凝血酶原片段F1 2水平升高。抑肽酶的给药不会影响基础条件下凝血酶原片段或血小板标志物表达的水平。然而,CPB后,抑肽酶组的血小板活化能力较高,如在TRAP激活后测量CD62P表达所示 (p = 0.05)。这项研究表明,小儿常温CPB引起血小板功能障碍,高剂量抑肽酶具有保护作用。

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