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体外膜氧化对凝血系统的影响
Tianlong Wang1, Weidong Yan2, Mingru Zhang3
1Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Disease, State Key Laboratory of Cardiovascular Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College.
Journal of visualized experiments : JoVE
|March 11, 2024
概括
长期清醒的体外膜氧化 (ECMO) 影响绵羊的凝血. 静脉动脉ECMO比静脉静脉ECMO显示出更高的激活部分血栓形成时间和血栓时间,在两组中都有脏梗塞.
科学领域:
- 心血管科学 心血管科学
- 血液学 血液学 血液学
- 医疗技术 医疗技术 医学技术
背景情况:
- 身体外膜氧化 (ECMO) 是一种生命支持疗法.
- 了解ECMO对凝血的影响对于患者安全至关重要.
- 长期清醒的ECMO会带来独特的生理挑战.
研究的目的:
- 调查长期清醒静脉动脉 (V-A) ECMO与静脉 (V-V) ECMO对绵羊模型凝血系统的影响.
- 为了比较V-A和V-V ECMO配置之间的凝血参数.
- 评估与清醒ECMO相关的潜在器官损伤.
主要方法:
- 十只健康的羊被分为V-A ECMO和V-V ECMO组 (每组n=5).
- 绵羊在ECMO启动后的7天内保持清醒.
- 监测了激活的凝血时间 (ACT),激活的部分血栓形成时间 (APTT) 和血栓时间 (TT).
- 氨酸剂量进行了调整,以保持目标ACT (220-250秒).
- 实验后检查了组织学.
主要成果:
- 无论是V-A和V-V ECMO组都需要增加肝素剂量,达到大约60 IU/kg/min.
- 与V-V ECMO组相比,V-A ECMO组显示出明显更高的APTT和TT值.
- 尽管在正常范围内波动,但实验室结果并不能完全预测两组观察到的脏梗塞焦点.
结论:
- 长期清醒的ECMO,特别是V-A配置,改变凝血参数不同于V-V ECMO.
- 在两种ECMO配置中都出现了损伤 (心脏病发作),这表明除了凝血之外还有潜在的系统性影响.
- 需要进一步的研究,以阐明在清醒 ECMO 期间器官损伤的机制,并优化抗凝策略.
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