狼抗凝剂和膜心脏手术
Pooja Bola Rajendra Devendra Kamath1, Deborah L Braham1, Deepa J Arachchillage2,3
1Department of Anaesthesia, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
Perfusion
|October 26, 2024
概括
狼抗凝剂 (LAC),一种促进凝血的抗体,在测试中悖论地延长了凝血时间. 这使得在心脏手术期间用未分离的肝素监测抗凝剂变得复杂.
科学领域:
- 血液学 血液学 血液学
- 免疫学 免疫学 免疫学
- 心血管外科心血管外科
背景情况:
- 狼抗凝剂 (LAC) 是一种抗脂抗体,在2%-4%的人口中存在.
- 尽管它的名字,LAC并不仅仅发生在狼中,也不会诱导抗凝;相反,它促进血块形成.
- LAC的目标是脂蛋白复合体,干扰细胞膜功能.
研究的目的:
- 突出LAC在外科手术期间管理中的临床影响.
- 为了强调在LAC的存在下,在心肺旁路 (CPB) 期间确保足够的抗凝固的困难.
- 讨论麻醉师和外科医生由于LAC对监测测试的影响而面临的挑战.
主要方法:
- 这是一个以临床观察为重点的病例报告.
- 该报告讨论了使用激活凝血时间 (ACT) 来监测抗凝血剂的使用.
- 它涉及在CPB心脏外科手术期间给药未分离的肝素 (UFH).
主要成果:
- 在体外,LAC表现出矛盾的效果,延长凝时间在脂依赖的试验,如激活部分血栓形成时间 (APTT).
- 在CPB期间,LAC复杂化了用于监测抗凝血的ACT测量.
- 在管理抗凝血水平方面,LAC的存在带来了重大挑战.
结论:
- 在外科手术期间的抗凝管理中,LAC带来了重大挑战,特别是在涉及CPB的心脏手术期间.
- 在LAC患者中,由于其对凝血试验的不可预测影响,难以准确监测抗凝血.
- 可能需要进一步的策略,以确保在接受CPB的LAC患者安全有效的抗凝药.
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