酸性环境对先天性心脏病患儿体外循环术后鱼精蛋白中和作用的影响  

Study on the dosage of protamine used in acidic environment after cardiopulmonary bypass in pa-tients with congenital heart disease

作　　者：郭淼 陈纲[2] 贺成光 贾兵[2] 

机构地区：[1]乌鲁木齐第一人民医院心胸外科,乌鲁木齐830011 [2]复旦大学附属儿科医院心血管中心

出　　处：《中国医师杂志》2012年第6期753-755,共3页Journal of Chinese Physician

摘　　要：目的探讨先天心性脏病术后患儿不同酸碱度对鱼精蛋白中和肝素的影响。方法回顾2011年3月至2011年4月间对108例先天性心脏病患儿行体外循环下行心脏直视手术的病例资料，分析其临床特点及不同血浆酸碱度时鱼精蛋白用量对术后引流的影响。结果在酸性环境下，鱼精蛋白中和肝素剂量及术后引流量[（136．8±22．8）m1]高于对照组[（112．6±22．7）m1]，差异有统计学意义（P〈0．01）。在非酸性环境下，鱼精蛋白和肝素比平均值为1．23：1；在pH〈7．30或剩余碱（BE）〈-6时，鱼精蛋白的用量显著增加，鱼精蛋白和肝素比平均值为1．86：1。结论不同的酸碱度对鱼精蛋白中和肝素有影响，酸性环境下鱼精蛋白的用量增加，术后引流量也会增多。在体外循环结束时，测得pH〈7．30或BE〈-6时，建议纠正酸碱平衡后按剂量使用加鱼精蛋白中和肝素。Objective To investigate the dosage of protamine to counteract heparin in patients with different pH values of after - surgery plasma of congenital heart defect. Meth. otis The clinical data of 108 patients during March 2011 to April 2011 with congenital heart diseases who underwent eardiopulmonary by- pass （CPB） surgery were reviewed. The volumes of chest tube drainage were analyzed to investigate the dos- age of protamine in patients with different pH values in plasma. Results The dosages of protamine and the volumes of chest tube drainage[ （ 136.8 ± 22. 8 ） ml] in patients with an acidic environmental plasma were higher than the patients in another group [ （ 112. 6±22. 7 ） ml ] （ P 〈 0. 01 ）. In patients with non-acidic environments, the mean ratio of dosage of protamine to heparin was 1.23： 1 ; meanwhile in patients with pH 〈7. 30 or base excess （BE） 〈 -6, the mean ratio was 1.86： 1. It suggested the dosage of of protamine in- creased significantly in patients with an acidic environmental plasma. Conclusions Different plasma pH values could change the dosage of protamine after cardiopulmonary bypass, and the acidic environment would increase the dosage of protamine and increase the volume of chest tube drainage after surgery. When pH 〈 7. 30 or BE 〈 -6 at the end of CPB, to correct acid-base balance first and then calculate the dose of protamine was recommended.

关 键 词：心脏缺损 先天性/外科学f病理生理学 体外循环 鱼精蛋白类l药理学 肝素/药 理学 

分 类 号：R654.2[医药卫生—外科学]