长托宁在CPB体外循环瓣膜置换术鱼精蛋白不良反应中的应用  

Efficacy of Penehyclidine Hydrochloride for Improving the Adverse Reactions of Protamine During Cardiopulmonary Bypass and Its Prevention and Care

作　　者：朱明瑶[1] 潘霞云[2] 陈安基[3] 谢朝菊[3] 刘红波[3] 

机构地区：[1]湖南常德职业技术学院 [2]湖南常德市第一人民医院药剂科,湖南常德415000 [3]湖南常德市第一人民医院麻醉科,湖南常德415000

出　　处：《医学临床研究》2011年第2期303-305,共3页Journal of Clinical Research

摘　　要：[目的]评价长托宁对体外循环瓣膜置换术（CPB-VR）鱼精蛋白不良反应的临床疗效.[方法]择期成人行CPB-VR中患者59例,随机分为两组：长托宁组 （A组,n=28）,对照组（B组,n=31）.麻醉诱导前10 min两组分别给予长托宁0.02 mg/kg和等体积生理盐水.观察各组鱼精蛋白不良反应发生情况,记录注射即刻（T0）和注射1 min（T1）、5 min（T2）和10 min（T3）、30 min（T4）内气道峰压（Ppeak）和收缩压（SBP） 肝素化前及鱼精蛋白拮抗后激活全血凝固时间（ACT）差值（R） 肝素与鱼精蛋白的比例（Ra）、术中和术后输血（RBC）和血浆（FP）总量、术后胸腔引流量及止血药物的应用等.[结果]两组鱼精蛋白不良反应发生率无差异（P〉0.05） SBP组间T0、T1比较均有差异（P〈0.05）,A组低于B组 Ppeak组间T1、T2比较均有差异（P〈0.05）,A组低于B组 两组R值及止血药剂量比较均有差异（P〈0.01）,A组低于B组 Ra值、胸腔引流量及RBC和FP总量比较无差异（P〉0.05）,但A组出血量和输血量均少于B组.[结论]麻醉前应用长托宁能够改善CPB-VR患者的鱼精蛋白不良反应,能够减少围术期出血量和输血量及止血药物的应用,提高临床护理疗效.[Objective]To compare and analyze the clinical care efficacy of penehyclidine hydrochloride （PHC） combined with different ratios of protamine reversal of heparin on the adverse reactions of protamine. [Methods]Fifty nine adults undergoing selective cardiopulmonary bypass-valve replacement （CPB VR） were selected and divided into 4 groups. Group A（ n 15） received PHC and protamine/heparin with the ratio of 1. 5-1.3：1. Group B（ n =13） received PHC and protamine/heparin with the ratio of 1.3-1.0：1. Group C（ n=18） received saline and protamine/heparin with the ratio of 1.5-1.3：1. Group D（ n=13） received sa line and protamine/heparin with the ratio of 1.3-1.3：1. PHC 0.02 mg/kg and isovolumic saline were given at 10min before induction of anesthesia. Adverse reactions of protamine were observed. The peak of airway pressure（Ppeak） and systolic blood pressure（SBP） before and 30min after injection were recorded. The differ ence（R） of activated accelerated clotting time（ACT） between before heparinization and after the reversal of protamine were also recorded. The ratio（Ra） of heparin and protamine, the volume of blood transfusion during and after operation, the volume of postoperative chest drainage, the application of hemostatic agents and the dose of additional protamine were analyzed. [Results]There was no difference in the incidence of adverse reactions of protamine among 4 groups（ P〈0.05）. There was significant difference in SBP among 4 group（ P〈 0.05）, and PHC and time points had interaction （ P〈0.05）. There was significant difference in Ppeak among 4 groups（ P〈0.05）, and PHC and protamine had interaction（ P〈0.05）. There were significant differences in R value, the total volume of perioperative blood transfusion, the volume of postoperative chest drainage, the application of hemostatic agents and the dose of additional protamine among 4 groups（ P〈0. 05）. The effect of group was the best, and that of group D was the worst. [Conclusi

关 键 词：心肺转流术 鱼精蛋白类/副作用 

分 类 号：R654.1[医药卫生—外科学]