Inhaled prostacyclin and platelet function after cardiac surgery and cardiopulmonary bypass

被引:34
作者
Haraldsson, Å
Kieler-Jensen, N
Wadenvik, H
Ricksten, SE [1 ]
机构
[1] Sahlgrens Univ Hosp, Dept Cardiothorac Anesthesia & Intens Care, S-41345 Gothenburg, Sweden
[2] Sahlgrens Univ Hosp, Dept Internal Med, S-41345 Gothenburg, Sweden
关键词
aerosol; prostacyclin; platelet function; cardiac surgery;
D O I
10.1007/s001340050044
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective. To study the effects of 6 h inhalation of aerosolized prostacyclin (PGI(2)) on platelet function. Design: In a prospective, double-blind, randomized study, 28 patients scheduled for elective cardiac surgery requiring cardiopulmonary bypass (CPB), received either 0.9% sodium chloride (n = 8), PGI(2) 5 mu g x ml(-1) (n = 10) or PGI(2) 10 mu g, ml(-1) (n = 10) as an aerosol for 6 h postoperatively. Setting: Cardiothoracic intensive care unit at a university hospital. Interventions: All patients were studied immediately after surgery during mechanical ventilation and sedation. The PGI(2) solutions or saline were administered with a jet nebulizer. Measurements and results: Bleeding time and chest tube drainage were measured. Blood samples for platelet aggregation, thrombelastography (TEG) and analysis of coagulation parameters and the stable prostacy clin metabolite 6-keto-PGF(1)alpha were obtained immediately before inhalation and after 2, 4 and 6 h of inhalation. After 6 h of PGI(2) inhalation, regardless of administered dose, there was a lower rate of platelet aggregation and a lower maximal increase in light transmission in response to adenosine diphosphate (ADP) than in the control group. The TEG variable reaction rime (R) was prolonged after 4 and 6 h of inhalation in the PGI(2) group receiving 10 mu g x ml(-1). There were no differences between groups with respect to bleeding time and chest tube drainage or any of the other variables examined. Conclusion: Inhalation of PGI(2) for 5 h in patients after cardiac surgery is associated with impaired platelet aggregation detected by in vitro techniques, with no in vivo signs of platelet, dysfunction.
引用
收藏
页码:188 / 194
页数:7
相关论文
共 38 条
[1]   AGGREGATION OF BLOOD PLATELETS BY ADENOSINE DIPHOSPHATE AND ITS REVERSAL [J].
BORN, GVR .
NATURE, 1962, 194 (4832) :927-&
[2]   PULMONARY AND ANTIAGGREGATORY EFFECTS OF PROSTACYCLIN AFTER INHALATION AND INTRAVENOUS-INFUSION [J].
BURGHUBER, OC ;
SILBERBAUER, K ;
HABER, P ;
SINZINGER, H ;
ELLIOTT, M ;
LEITHNER, C .
RESPIRATION, 1984, 45 (04) :450-454
[3]  
DECATERINA R, 1994, BLOOD, V84, P3363
[4]   The in vitro effects of isoflurane, sevoflurane, and propofol on platelet aggregation [J].
Dogan, IV ;
Ovali, E ;
Eti, Z ;
Yayci, A ;
Gögüs, FY .
ANESTHESIA AND ANALGESIA, 1999, 88 (02) :432-436
[5]   Inhalation of prostacyclin (PGI(2)) for 8 hours does not produce signs of acute pulmonary toxicity in healthy lambs [J].
Habler, O ;
Kleen, M ;
Zwissler, B ;
Pusch, R ;
Welte, M ;
Vogelmeier, C ;
Kempter, B ;
Krombach, F ;
Messmer, K .
INTENSIVE CARE MEDICINE, 1996, 22 (05) :426-433
[6]   Comparison of inhaled nitric oxide and inhaled aerosolized prostacyclin in the evaluation of heart transplant candidates with elevated pulmonary vascular resistance [J].
Haraldsson, Å ;
Kieler-Jensen, N ;
Nathorst-Westfelt, U ;
Bergh, CH ;
Ricksten, SE .
CHEST, 1998, 114 (03) :780-786
[7]   Inhaled prostacyclin for treatment of pulmonary hypertension after cardiac surgery or heart transplantation: A pharmacodynamic study [J].
Haraldsson, A ;
KielerJensen, N ;
Ricksten, SE .
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 1996, 10 (07) :864-868
[8]   BRONCHOCONSTRICTOR AND ANTIBRONCHOCONSTRICTOR PROPERTIES OF INHALED PROSTACYCLIN IN ASTHMA [J].
HARDY, CC ;
BRADDING, P ;
ROBINSON, C ;
HOLGATE, ST .
JOURNAL OF APPLIED PHYSIOLOGY, 1988, 64 (04) :1567-1574
[9]   Propofol has both enhancing and suppressing effects on human platelet aggregation in vitro [J].
Hirakata, H ;
Nakamura, K ;
Yokubol, B ;
Toda, H ;
Hatano, Y ;
Urabe, N ;
Mori, K .
ANESTHESIOLOGY, 1999, 91 (05) :1361-1369
[10]   BLEEDING-TIME PROLONGATION AND NO INHALATION [J].
HOGMAN, M ;
FROSTELL, C ;
ARNBERG, H ;
HEDENSTIERNA, G .
LANCET, 1993, 341 (8861) :1664-1665