采用血栓弹力图监测冠状动脉旁路移植术对血小板功能的影响

摘要

目的：用血栓弹力图（ TEG）监测体外循环下冠状动脉旁路移植术（ CABG）与非体外循环下冠状动脉旁路移植术（ OPCAB）对患者凝血及血小板功能的影响。方法连续选取2012年4月至12月患者48例，前瞻性随机分为CABG组（ n＝28）和OPCAB组（ n＝20）。分别于肝素化前5 min及鱼精蛋白中和后10 min经中心静脉导管采血，采用TEG 及Platelet Map-pingTM系统检测两组患者的凝血和血小板功能，同时测定激活全血凝固时间（ ACT）及血常规。记录术后出血量及同种异体输血量。结果两组患者鱼精蛋白中和后相比肝素化前 ACT、R 值、K 值及α角均无显著差异；但 MA 值、血小板抑制率（INHADP、INHAA）差异显著（ P＜0．05）。肝素化前两组患者的ACT值及TEG参数值相比无显著差异；鱼精蛋白中和后两组患者的R值、K值及α角相比差异不显著，但 MA值、INHADP、INHAA相比差异显著（ P＜0．05）。术后OPCAB组引流量及输血量明显少于CABG组（ P＜0．05）。结论血小板功能受损是导致CABG凝血功能受损的主要原因。与CABG相比，OPCAB有益于保护血小板和凝血功能，减少术后异常出血及输血量。%Objective This study was designed to evaluate the changes of coagulation and platelet function in patients under-going coronary artery bypass grafting with or without cardiopulmonary bypass ( CPB) by thromboelastography ( TEG) and platelet map-ping. Methods Between April 2012 and December 2012, 48 consecutive patients received coronary artery bypass. They were random-ly assigned to two groups. 20 underwent off-pump coronary artery bypass ( OPCAB group) and 28 underwent coronary artery bypass grafting ( CABG) with CPB ( CCABG group) . Blood samples were collected at 5 minutes before heparinization and 10 minutes after heparin neutralization. Coagulation function was studied with TEG and platelet mapping assay, activated clotting time ( ACT) and blood routine analysis. Postoperative blood loss and transfusion were recorded. Results There were no significant differences in TEG assay and ACT between groups before heparinization. After heparinization, R-time, K-time and α-angle were insignificantly different be-tween the two groups, while maximal amplitude and inhibition of platelet were significantly different. Furthermore, R-time, K-time was slightly increased, andα-angle (α) was slightly decreased after neutralization, but maximal amplitude was significantly lower and inhibition of platelet was significantly increased in the CCABG groups ( P<0.05) . Postoperative blood loss and transfusion in OPCAB group were both lower than those in CCABG group. Conclusion Impairment of platelet function contributes primarily to the postopera-tive dysfunction of coagulation. Compared with CCABG, OPCAB is in favor of protection of platelet function and coagulation, helping lower postoperative bleeding and transfusion volume.