兔心脏骤停体外心肺复苏模型不同抗凝策略比较

Comparison of different anticoagulation strategies in extracorporeal cardiopulmonary resuscitation model of rabbit cardiac arrest

摘要:

目的 比较不同抗凝策略（比伐卢定与普通肝素）在兔心脏骤停体外心肺复苏模型中的安全性和有效性。方法 采用随机数字表法将12只健康雄性新西兰兔分为比伐卢定组和普通肝素组，每组6只。复制窒息型心脏骤停模型，随后启动体外心肺复苏，并分别给予比伐卢定和普通肝素抗凝治疗。收集实验动物实验前基线资料、体外膜肺氧合后12和24 h血小板及凝血功能指标、血栓及出血情况，计算活化部分凝血活酶时间（APTT）变异系数和APTT达标率。通过比较相关结果验证不同抗凝策略的安全性和有效性。结果 两组动物实验前基线心率、平均动脉压、血小板计数、凝血酶原时间、凝血酶原时间-国际标准化比值、APTT、纤维蛋白原及D-二聚体比较，差异无统计学意义（P >0.05）。两组动物ECPR后12、24 h 血小板及凝血功能指标比较，差异均无统计学意义（P >0.05）；两组动物出血及血栓发生率比较，差异均无统计学意义（P >0.05）；与普通肝素组相比，比伐卢定组APTT变异系数降低（P <0.05），APTT达标率升高（P <0.05）。结论 兔心脏骤停体外心肺复苏模型中，比伐卢定抗凝策略的有效性较普通肝素高，安全性差异不显著，可作为普通肝素的一种新型替代物。

Abstract:

Objective To compare the safety and effectiveness of different anticoagulation strategies (bivalirudin and unfractionated heparin) in a rabbit extracorporeal cardiopulmonary resuscitation (ECPR) model of cardiac arrest.Methods Twelve healthy male New Zealand rabbits were randomly assigned to the bivalirudin group and the unfractionated heparin group, with 6 rabbits in each group. An asphyxial cardiac arrest model was replicated, followed by initiation of ECPR, and bivalirudin and unfractionated heparin anticoagulation treatments were administered. Baseline data before the experiment, platelet and coagulation function indicators at 12 and 24 hours after ECPR, and information on thrombosis and bleeding were collected. The coefficient of variation (CV) and the rate of achieving the activated partial thromboplastin time (APTT) standard were calculated. The safety and effectiveness of different anticoagulation strategies were verified by comparing the relevant results.Results There were no statistically significant differences in baseline heart rate, mean arterial pressure, platelet count, prothrombin time, prothrombin time-international normalized ratio, APTT, fibrinogen, and D-dimer between the two groups before the experiment (P > 0.05). There were no statistically significant differences in platelet and coagulation function indicators at 12 and 24 hours after ECPR between the two groups (P > 0.05). There were no statistically significant differences in bleeding and thrombosis between the two groups (P > 0.05). Compared with the unfractionated heparin group, the bivalirudin group showed a lower APTT CV (P < 0.05) and a higher APTT achievement rate (P < 0.05).Conclusion In a rabbit ECPR model of cardiac arrest, the effectiveness of the bivalirudin anticoagulation strategy is higher than that of unfractionated heparin, and the safety difference is not significant. Bivalirudin can be considered as a new alternative to unfractionated heparin.