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不同劑量肝素在體外循環(huán)心臟手術(shù)中應(yīng)用的比較研究

Comparison of two heparin doses during cardiopulmonary bypass surgery

作者: 饒效  肖立瓊  陳雯  黃福華  汪黎明  陳鑫 
單位:南京醫(yī)科學(xué)大學(xué)附屬南京第一醫(yī)院心胸血管外科(南京210006)
關(guān)鍵詞: 肝素;體外循環(huán);活化凝血時(shí)間;凝血 
分類(lèi)號(hào):
出版年·卷·期(頁(yè)碼):2012·31·4(415-421)
摘要:

目的觀察兩種不同劑量的肝素在體外循環(huán)心臟手術(shù)的一系列相關(guān)指標(biāo)的差異,以評(píng)估低劑量肝素用于該手術(shù)的臨床應(yīng)用效果。方法將60例需要體外循環(huán)(CPB)心臟外科手術(shù)的患者隨機(jī)分成兩組,分別采用2 mg/kg(n=30)和3 mg/kg(n=30)的初始肝素劑量,比較兩組患者在術(shù)中和術(shù)后凝血功能、肝素化后活化凝血時(shí)間(ACT)、肝素總用量、魚(yú)精蛋白量、微栓過(guò)濾網(wǎng)黏附度、術(shù)中和術(shù)后輸血量、血小板數(shù)量、術(shù)后24 h胸引量以及手術(shù)并發(fā)癥等相關(guān)指標(biāo)。結(jié)果2 mg/kg組(低劑量組)中有1例患者肝素化ACT未達(dá)400 s,3 mg/kg組(常規(guī)組)中ACT全部達(dá)到400 s以上。兩組患者術(shù)中及術(shù)后均無(wú)心梗、腦梗及肺栓塞等血栓栓塞并發(fā)癥發(fā)生,微栓過(guò)濾器黏附度、術(shù)后輸血量、血小板數(shù)量、術(shù)后24 h胸引量等指標(biāo)均無(wú)統(tǒng)計(jì)學(xué)差異(P>0.05)。相對(duì)于常規(guī)組,低劑量組的肝素化ACT較低(P<0.05),總肝素量、魚(yú)精蛋白量和術(shù)中庫(kù)血輸入量明顯減少(P<0.05)。2組在血漿凝血酶原時(shí)間 (PT,CPB 20 min和術(shù)后24 h)、纖維蛋白原(Fib,CPB 40 min和術(shù)后24 h)指標(biāo)上也存在差異(P<0.05)。結(jié)論與常規(guī)劑量肝素相比,采用低劑量肝素同樣能使多數(shù)患者肝素化ACT值大于400 s,滿(mǎn)足體外循環(huán)手術(shù)需求,減輕凝血功能紊亂,并減少術(shù)中輸血量。

Objective To observe a series of correlated index and to evaluate the effects of two heparin doses during cardiopulmonary bypass (CPB) surgery. Methods Sixty patients eligible for CPB surgery were divided randomly into low-dose heparin (2 mg/kg, n=30) group and conventional heparin (3 mg/kg, n=30) group. The function of blood coagulation during and after surgery, activated coagulation time (ACT) after injection of haparin, the total heparin doses, the protamine doses, the microembolus filter screen adhesion degrees, transfusion of allogeneic blood, platelet counts (PLT), the amount of postoperative chest drainage at 24 h, mortality and morbidity were recorded for the two groups. Results In the low-dose heparin group, only one patient was unsufficient to achieve target ACT while target ACT was achieved in all the patients of the conventional group. No complication of myocardial infarction, cerebral and pulmonary embolism was detected in the patients during the operation and postoperation. There was no difference between the two groups in terms of the microembolus screen pack cleaning degree, postoperative blood transfusion, postoperative chest drainage at 24h and platelet counts (PLT), yet the ACT values after heparin administration of the low-dose heparin group was lower than the conventional group. The total heparin dose and the blood transfusion intraoperation were remarkably reduced in the low-dose group. The differences of prothrombin time (PT) at CPB20min and postoperative 24h, fibrinogen (Fib) at CPB 40 min and postoperative 24h in the two groups were significant. Conclusions Compared with conventional heparin (3mg/kg), most patients in low dose heparin (2mg/kg) can reach target ACT (400s) after injection of initial heparin, meet the demand of CPB surgery, and also reduce blood coagulation disorders and blood transfusion intraoperation.

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