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Deep hypothermic circulatory arrest and selective cerebral perfusion induced reversible thrombocytopenia during aortic arch repair

  • 血小板減少
  • 低体温循環停止
  • 大動脈弓部置換
  • Thrombocytopenia
  • Deep Hypothermic Circulatory Arrest
  • Aortic Arch Repair
  • Medicine


目的:本研究は低体温循環停止(deep hypothermic circulatory arrest:DHCA)を用いた大動脈弓部置換術中の可逆的血小板減少に関しての調査である.方法:前向き観察研究として,DHCA 下に大動脈弓部置換術を施行した35 症例を対象とした.経時的な血小板数変化の測定と関連因子の検索を施行した.結果:患者は人工心肺(cardiopulmonary bypass:CPB)開始,DHCA 時に有意な血小板数低下を呈した.DHCA 終了時に平均47.1% までの血小板減少を認めた.うち4 例では2 万以下の著明な低下を認めた.復温後,CPB 終了時には80.8% にまで回復した.血小板減少の程度はCPB やDHCA 時間とは相関を認めなかった.結論:大動脈弓部置換術中,CPB およびDHCA は有意な血小板減少を惹起した.CPB 終了時には回復しており,可逆的であると考えられる.CPB やDHCA 時間など,多数の因子との間に相関関係はなく,今回の可逆的血小板減少の関連因子を特定するには至らなかった.臨床的意義を見いだすためにも血小板機能評価をはじめとする更なる研究を必要とする.Background: We investigated the reversibility of thrombocytopenia during aortic arch surgery under deep hypothermic circulatory arrest (DHCA). Methods: This prospective observational study enrolled 35 patients who underwent aortic arch surgery under DHCA. Results: All patients developed significant thrombocytopenia after initiation of cardiopulmonary bypass (CPB) and DHCA. The mean decrement in platelet count was 69.2% during CPB and 47.1% at the end of selective cerebral perfusion (SCP) and lower body circulatory arrest. The platelet count returned to 80.8% of the initial value after CPB was completed. The degree of thrombocytopenia was not correlated with the duration of CPB or DHCA. Conclusions: CPB and DHCA induced significant thrombocytopenia during aortic arch repair. This reduction in platelet count appeared to be reversible because it returned to almost 80% of the initial value after completion of CPB. Because no significant correlation with duration of CPB or DHCA was observed, the mechanism responsible for thrombocytopenia and its resolution could not be identified. Further study is necessary to determine whether thrombocytopenia is due to reversible sequestration of platelets during hypothermia.

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