【摘要】 目的　观察体外膜肺 (ECMO)对绵羊血液系统的影响。方法　 13只健康绵羊 ,静脉注射肝素 2 0 0U/kg后 30min ,经静脉 动脉通路进行体外循环 ,观察静脉注射肝素前 (实验前 )、注射肝素后 30min (ECMO前 )及ECMO后血小板计数、血小板聚集率、凝血酶原时间 (PT)、活化部分凝血活酶时间 (APTT)及白细胞计数 (WBC)的变化。结果　ECMO 1h时血小板计数从实验前的 (2 5 9± 12 2 )×10 9/L下降到 (140± 71)× 10 9/L ,ECMO 3h血小板为 (131± 5 1)× 10 9/L ,与实验前比较差异均有非常显著意义 (q′分别为 4 5 7和 4 90 ,P均 <0 0 1)。ECMO前血小板聚集率与实验前比较略有下降 ,但差异无显著意义。ECMO开始后 3h ,胶原和二磷酸腺苷 (ADP)诱导的血小板聚集率分别从ECMO前的(42± 13) %和 (40± 10 ) %下降到 (32± 11) %和 (31± 8) % (q′分别为 3 10和 3 2 1,P均 <0 0 5 )。PT和APTT在ECMO开始后 1h均明显延长 ,与实验前和ECMO前比较 ,差异均有非常显著意义 (P均 <0 0 1)。ECMO开始后 1h ,WBC从实验前的 (12 1± 4 1)× 10 9/L下降到 (3 9± 2 9)× 10 9/L(q′ =7 6 2 ,P <0 0 1) ,ECMO 3h ,WBC仍在较低水平 ,与实验前比较 ,差异仍有非常显著意义 (q′ =6 0 0 ,P <0 0 1)。停ECMO 2 4h ,血小板计数、血更多还原

【Abstract】 Extracorporeal membrane oxygenation (ECMO) has been used to treat severe respiratory failure since 1970s and has been proved effective. However, its clinical application was limited by its severe bleeding complications. Objective To evaluate the effects of ECMO on blood system in sheep. Methods Thirteen healthy sheep weighing (23±6) kg were enrolled in the experiment without sex discrimination. After intravenous administration of heparin in a dosage of 200 U/kg, the right internal jugular vein and common carotid artery were cannulated and then connected to extracorporeal circuit which was initially primed with normal saline and anticoagulated fresh sheep blood. The circuit was run 3 4 hours with flow rates of 50 100 ml/(kg·min). The platelet count, platelet aggregation, prothrombin time (PT), activated partial thromboplastin time (APTT) and white blood cells (WBC) were measured before experiment, before ECMO (i.e. 30 minutes after intravenous administration of heparin), at the 1st hour and the 3rd hour during ECMO, at the 2nd and the 24th hour post ECMO, respectively. Results Platelet counts after the initiation of ECMO decreased to (140±71)×10 9/L at the 1st hour and to (131±51)×10 9/L at the 3rd hour, which showed remarkable significance in comparison with the counts before the experiment ( q ′=4.57 and 4.90, respectively, P <0.01). Thirty minutes after intravenous administration of heparin, the modest impairment of platelet aggregations were found, but the changes were no statistically significant. The significant decline of platelet aggregations was observed at the 3rd hour during ECMO. The aggregation rates induced by collagen and ADP decreased from (42±13)% and (40±10)% 30 minutes after heparin administration to (32±11)% and (31±8)%, respectively ( q ′=3.10 and 3.21, respectively, P <0 05). PT and APTT were prolonged significantly at the 1st hour during ECMO in comparison with the levels before the experiment [(75±48) seconds vs (21±3) seconds for PT, (196±33) seconds vs (39±7) seconds for APTT, P <0.01]. At the 1st hour of ECMO, WBC decreased from (12.1±4.1)×10 9/L to (3.9±2.9)×10 9/L ( q ′=7.62, P <0.01). At the 3rd hour of ECMO, WBC remained at a lower level and was significantly different from the base level ( q ′=6.00, P <0.01). The platelet count, platelet aggregations, PT, APTT and WBC returned to normal at the 24th hour post ECMO. Conclusion Transient decline of platelet and WBC counts and abnormalities of platelet aggregations and coagulation occurred during ECMO, and returned to normal spontan eously within 24 hours post ECMO.更多还原