逆行性自原始对凝血的作用,通过旋转血栓形成显微镜评估在接受膜心脏手术的患者中的凝血
Seo Hee Ko1, Zhengyu Nan1, Sarah Soh1
1Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Journal of cardiothoracic and vascular anesthesia
|January 23, 2024
概括
逆行自主原始化 (RAP) 在经历了膜心脏手术的患者中没有改善凝血功能,通过旋转血栓形成显微镜 (ROTEM) 测量. 在RAP和常规原始化组中,心肺旁路干扰了凝血.
科学领域:
- 麻醉学 麻醉学
- 心血管外科心血管外科
- 血液学 血液学 血液学
背景情况:
- 心肺绕道 (CPB) 可以损害凝血功能.
- 逆行自主原始化 (RAP) 是一种在CPB期间减少异性血液产品输血的技术.
- 在膜心脏手术中RAP对凝血功能的影响尚未完全理解.
研究的目的:
- 调查逆行自主原始化 (RAP) 对凝血功能的影响.
- 在心脏膜手术期间,比较RAP和常规启动之间的凝血参数.
- 为了评估凝血,使用旋转血栓形成显微镜 (ROTEM).
主要方法:
- 前性,随机的,患者和结果评估者盲目的研究.
- 接受了膜心脏手术的104名患者被随机分配到RAP或对照组.
- 旋转血栓形成显微镜 (ROTEM) 用于在多个时间点评估凝血.
主要成果:
- 逆行自主原始化 (RAP) 删除了平均635毫升的原始体积.
- 这两组在ROTEM治疗心肺旁路术 (CPB) 后都显示出凝血功能受损.
- 在RAP和对照组之间没有观察到血红素,凝血参数或血液产品输血率的显著差异.
结论:
- 心肺旁路系统显著损害了凝血功能.
- 逆行自主原始化 (RAP) 在改善凝血功能方面没有比传统原始化提供优势.
- 可能需要进一步的研究来探索在心脏手术期间管理凝血的替代策略.
相关概念视频
Extrinsic and Intrinsic Pathways of Hemostasis
Blood clotting or coagulation involves extrinsic and intrinsic pathways, which ultimately merge into the common pathway, forming a fibrin clot.
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which forms a...
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which forms a...
Clot Retraction and Fibrinolysis
After a fibrin clot is formed, the next step is clot retraction, a vital process facilitated by platelet contractile proteins, such as actin and myosin. These proteins pull the fibrin strands closer together and condense the clot. This action reduces the size of the clot, creating a smaller, denser structure that effectively seals off the damaged vessel. Clot retraction consolidates the clot and helps with wound healing by bringing the edges of the damaged blood vessel closer together.


