基于体重的肝素负荷剂量下体重指数对活化凝血时间的影响  

Effect of Body Mass Index on Activated Clotting Time in Patients Received Weight-Based Dosing of Unfractionated Heparin

作　　者：洪霞[1] 单培仁[1] 黄伟剑[1] 朱千里[1] 肖方毅[1] 李晟[1] 周浩[1] 

机构地区：[1]温州医学院附属第一医院心内科,325000

出　　处：《心电与循环》2012年第2期74-76,共3页Journal of Electrocardiology and Circulation

摘　　要：目的 探讨在经皮冠状动脉介入（PCI）治疗中，基于体重的肝素负荷剂量下体重指数（BMI）对全血活化凝血时间（ACT）的影响。方法前瞻性入选男性冠心病患者78例，年龄45～77（63．86±6．89）岁，以BMI为依据将患者分为4组：A组20例（15．57≤BMI〈23．03）。B组20例（23．03≤BMI〈25．35），C组18例（25．35≤BMI〈27．68），D组20例（BMI≥27．68）。所有患者给予100U／kg负荷全量肝素，并于术前、肝素负荷剂量后5min、10min、30min、60min抽血，采用Hemotec法检测ACT值，以术前ACT（ACT0）为基线，其余ACT值与其差值分别标记为△ACTs，MATLAB软件计算△ACT一时间曲线下面积。结果负荷肝素后ACT达峰时间各不相同：33．33％位于ACT5时间点，51．33％位于ACT10时间点，15．34％位于ACT30时间点，各组间差异有统计学意义（P〈0．05）。△ACT-时间曲线下面积随着BMI增大而增大，各组间差异有统计学意义（P〈0．01）。结论相对于低BMI患者，基于实际体重给予负荷量肝素对于大BMI患者是过量的。Objective To assess the effect of body mass index （BMI） on activated clotting time （ACT） in patients received weight-based dosing of unfractionated heparin （UFH） during percutaneous coronary intervention. Methods 78 male inpatients with a coronary heart disease were divided into 4 groups according to BMI： group A （15.57≤〈BM1〈23.03, n= 20）, group B （23.03≤BMI〈25.35,n=20）, group C （25.35≤〈BMI〈27.68,n=18）, and group D （27.68≤BMI,n=20）. All patients received a bolus of 100 U / kg UFH before procedure. ACT was measured by Hemotec method before and at 5 minutes, 10 minutes, 30 minutes and 60 minutes after UFH. ACT difference between before and after UFH was marked as AACT. Area under the curve （AUC） of AACT-time was calculated by MATLAB software. Results Peak ACT achieved at 5 minutes after UFH in 33.33% patients, at 10 minutes in 51.33% patients, and at 30 minutes in 15.34% patients. The time of peak ACT was significantly different between any two groups （all P〈0.05）. AUC of △ACT-time increased as BMI increased and was significantly different among the four groups（P〈0.01）. Conclusion Weight-based dosing may result in UFH overdose for patients with higher BMI compared to patients with lower BMI.

关 键 词：普通肝素 活化凝血时间 体重指数 

分 类 号：R459.5[医药卫生—治疗学]