围体外循环期间活化凝血时间和激活部分凝血活酶时间与未分段肝素浓度相关性分析的初步研究  

The correlation of ACT or APTT and concentration of unfraction heparin during and after cardiopulmonary bypass

作　　者：邢智辰[1] 贾在申[1] 孙志全[1] 侯晓彤[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管病症研究所体外循环及机械辅助循环科成人心脏危重症中心,100029

出　　处：《心肺血管病杂志》2015年第12期913-915,共3页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都卫生发展科研专项项目(首发2014-1-1051)

摘　　要：目的:研究体外循环手术前后,活化凝血时间(ACT)与激活部分凝血活酶时间(APTT)指标,在反应患者体内肝素实际浓度方面的价值。方法:采用观察性研究,选取因心脏瓣膜疾病需要进行体外循环下瓣膜置换手术的患者39例,于手术过程中和术后24小时内间断抽取血样进行ACT及APTT监测,并保存血浆进行活化凝血因子抗FIIa因子及抗F_(Xa)因子定量检测,作为肝素实际浓度的指标。结果:在体外循环手术过程中全身肝素化,体内肝素浓度与ACT呈明显正相关(F_(Ⅱa)因子r=0.397,P<0.001;F_(Xa)因子r=0.461,P<0.001),停止体外循环后中和肝素,体内肝素浓度与ACT无相关(F_(Ⅱa)因子r=0.242,P=0.057;F_(Xa)因子r=0.300,P<0.001),与APTT正相关(F_(Ⅱa)因子r=0.397,P=0.008;F_(Xa)因子r=0.391,P=0.010)。结论:体外循环过程中ACT是良好的体内肝素浓度评价指标,肝素中和后APTT及ACT都不能完全准确反应体内肝素浓度,APTT与实际肝素浓度的相关性要优于ACT。Objective： This study was designed to evaluate the correlation between ACT and APTT and the actual concentration of heparin in patients. Methods： This is an observational study,to investigate 39 patients undergoing valve replacement surgery under cardiopulmonary bypass. Blood samples were collected during the operation and within 24 hours postoperation to test ACT and APTT,and plasma was isolated to detect factor FⅡaand F_（Xa）as the indicators of the actual concentration of heparin. Results： Systemic heparin was proceed during cardiopulmonary bypass,heparin was positively correlated with ACT,the correlation was（ F_（Ⅱar） = 0. 397,P 〈0. 001; F_（Xar） = 0. 461,P 〈0. 001）. Heparin was neutralized after cardiopulmonary bypass,the correlation between concentration of heparin and ACT was（ F_（Ⅱar） = 0. 242,P = 0. 057; F_（Xar） = 0. 300,P〈 0. 001）,APTT was（ F_（Ⅱar） = 0. 397,P = 0. 008; F_（Xar） = 0. 391,P = 0. 010）. Conclusion： In the process of cardiopulmonary bypass,ACT was an ideal indicator for heparin concentration. Both ACT and APTT could not reflect concentration of heparin accurately after heparin was neutralized,and the correlation between APTT and the actual heparin concentration in vivo was better than ACT.

关 键 词：体外循环 活化凝血时间 凝血活酶时间 肝素浓度 

分 类 号：R54[医药卫生—心血管疾病]