心脏手术鱼精蛋白过敏反应的治疗经验  

The clinical management of adverse reaction of protamine in cardiac surgery

作　　者：方万香[1] 何庚戌[1] 陈连武[1] 刘俊堂[2] 李海英[1] 周峰[1] 刘颖[1] 孙明哲[2] 

机构地区：[1]解放军251医院心胸外科,张家口075000 [2]解放军251医院麻醉科,张家口075000

出　　处：《中国体外循环杂志》2010年第1期39-40,共2页Chinese Journal of Extracorporeal Circulation

摘　　要：目的分析及探讨心脏直视手术鱼精蛋白过敏反应防治的体外循环管理经验。方法回顾性总结五年内心脏直视手术619例病例资料,其中发生鱼精蛋白过敏反应36例,发生率为5.8%。33例发生于常规体外循环术后中和肝素之后,3例发生于备体外循环不停跳冠状动脉旁路移植术中中和肝素时。结果36例鱼精蛋白过敏患者当中反应较轻的31例,经过减慢或停止鱼精蛋白输注,结合相应的对症处理,很快得以恢复。5例出现重度过敏反应,经抗过敏、血管活性药物等处理效果不佳,果断再次肝素化体外循环转流后转危为安,抢救成功率100%。结论鱼精蛋白过敏反应难以预测,中重度反应死亡率高;适量的鱼精蛋白应用、及早的准确判断和及时再次体外循环可有效地提高抢救成功率。OBJECTIVE To summarize the management of adverse reaction after protamine administration during cardiac surgery. METHODS From 2006 to 2008, 619 cases of cardiac operation was retrospectively analyzed. 36 patients experienced from mild to moderate - severe reactions. The incidence was 5.8%. 33 patients occurred in open heart surgery under extracorporeal circulation, 3 patients occurred in off pump CABG procedure. All adverse reaction occurred sooner after protamine administration. RESULTS 31 patients had mild reactions to protamine, and were cured through decreasing the administrating rate or stoping administration＇ and agreesive use of epinephine, antihistamines and steriods, and rapid volume supplementt; 5 patients experienced severe adverse reaction, and was treated with rehaprinization and use of extracorporeal circulation, one patient was inserted with intraaortic balloon pump to assist the circulation. All patients recovered from the adverse reaction of protamine. CONCLUSION The advese reaction to protamine is difficult to predict, and the prognosis of moderate - severe reactions is very poor. Proper protamine dose, early recognition of the clinical characteristics and prompt re -bypass are very important managements for successful rescue.

关 键 词：心脏直视手术 鱼精蛋白 过敏 体外循环 

分 类 号：R654.1[医药卫生—外科学]