| Objective To compare the changes of the expression of platelet membrane glycoprotein in open-heart surgery patients undergoing cardiopulmonary bypass using Voluven(6%hydroxyethyl starch,molecular weight of 130 kDa/degree of substitution 0.4)with Gelofusin(4%succinylated gelatin).Further explore the possible mechanism of the two plasma substitute on platelet function.Methods Thirty ASAⅡ～Ⅲcongenital heart disease patients undergoing elective open heart surgery with cardiopulmonary bypass were randomly divided into two groups,15 patients were in the 6%hydroxyethyl starch130/0.4(voluven group,V group),others were in the 4%succinylated gelatin(gelofusin group,G Group).Blood sample were collected at the following time point:after anesthesia before operation(Baseline,T1),10 minute after protamine administration(T2),the end of operation(T3),24 hour after operation(T4).Flow Cytometrie Analysis was perofmred to determine platelet activation(P-seletion,CD62p)and the expression of GPⅡb/Ⅲa,and platelet count,haemoglobin(HB),ACT and blood[Ca2+]were also measured.The operation time,the CPB time,the dose of heparin,the volume of the colloid, postoperative blood losses and allogeneic transfution were documented.Results 1.The comparison of the expression of platelet membrane glycoprotein between two groups:(1)There was no statistically significant difference at T1,T4 between V group and G group,the V group was statistically significant lower than G group(P＜0.05)at T2,T3;and there was statistically significant higher at T2 andT3 than T1(P＜0.05),there was no statistically significant difference betweenT4 and T1 in both groups(P＞0.05).(2)There was no statistically significant difference between two groups(P＞0.05),but was statistically significant difference higher at T2 and T3 than T1(P＜0.05),and there was no statistically significant difference betweenT4 and T1 in both groups (P＞0.05).2.The comparison of platelet count,HB,ACT,blood[Ca2+]:(1) There were no statistically significant difference between two groups(P＞0.05).(2)The platelet count was statistically significant lower at T2,T3than T1 (P＜0.05).(3)Blood[Ca2+]was statistically significant lower at T2,T3, T4than T1(P＜0.05).(4)HB was significant statistically difference at T2 than T1 (P＜0.05).(5)ACT was no statistically significant difference in the three time-points(P＞0.05)than T1 in both groups.3.There was no statistically significant difference of the operation time,the CPB time,the dose of heparin, the volume of the colloid,postoperative blood losses and allogeneic transfution (P＞0.05).Conclusions 1.6%hydroxyethyl starch130/0.4 inhibit platelet function more than 4%succinylated gelatin because it inhibit the expression of the platelet GPⅡb/Ⅲa,the coating phenomenon of the 6%hydroxyethyl starch130/0.4 blocking the access of endogenous ligands to the platelet membrane glycoprotein maybe responsible for antiplatelet effect.2.The open heart surgery with cardiopulmonary bypass can cause the changes of expression of platelet membrane glycoprotein and affect the platelet function. |
