体外肝素浓度递进法预测心脏手术患者肝素有效剂量的临床研究  

Clinical study on heparin effective dose predicted by in vitro heparin concentration progressive in patients undergoing heart surgery

作　　者：马海平[1] 姜巧巧[1] 王江[1] 张永强[1] 罗丹[1] 郑宏[1] 

机构地区：[1]新疆医科大学第一附属医院麻醉科,830054

出　　处：《实用医学杂志》2017年第23期3906-3911,共6页The Journal of Practical Medicine

基　　金：新疆维吾尔自治区自然科学基金(编号:2015211C058)

摘　　要：目的本研究探索肝素剂量曲线(HDR)和体外肝素浓度递进(HCP)两种预测肝素初始剂量的方法,评估HCP对心脏手术患者精准肝素用量的预测价值。方法纳入18~65岁择期行心脏手术的患者,在手术开始之前抽取颈静脉血进行HCP(2.5、3.0 mg/kg)试验;手术过程中经颈静脉首次给予肝素2 mg/kg,然后每隔5分钟每次追加肝素0.5 mg/kg直至总量达到2.5、3.0 mg/kg,并分别测ACT值且使ACT≥480 s;根据HDR计算出每位患者2.5、3.0 mg/kg的ACT值;分别根据HCP和HDR两种方法所得到的ACT值与实际体内所测得相对应的值进行比较。结果将HDR和HCP两种方法所测得ACT值与体内相应剂量的ACT值进行比较发现:体外HCP与体内相应浓度的肝素实测ACT值之间有较好相似性(r值分别为0.62和0.74),P<0.05;HDR与体内相应浓度肝素的实测ACT值之间也有较好相似性(r分别为0.66和0.54),P<0.05;但HDR和HCP与体内实际的结果比较发现,体外HCP的预测结果特别是3.0 mg/kg与体内实测值相似度更高。结论 HCP相对于HDR法预测满足体外循环所需抗凝效果的肝素剂量方面有较高的准确性。Objective To explore two methods for predicting the initial dose of heparin by heparin dose re- sponse curve （HDR） and in vitro heparin concentration progressive （HCP）, and evaluate the predictive value of HCP for precise heparin dosage in patients undergoing cardiac surgery. Methods 18 - 65 years old patients un- dergoing selective cardiac surgery were included in the study. Before the start of surgery, internal jugular vein blood was collected for the HCP test （2.5, 3.0 mg/kg）. During the operation, the first injection with heparin 2 mg/ kg via the internal jugular vein, followed by additional heparin 0.5 mg/kg every 5 minutes until the dose amounted to 2.5 mg/kg, 3.0 mg/kg. ACT was measured respectively until ACT value i〉 480 s. According to HDR, the ACT values in every patient were calculated at 2.5 mg/kg, 3.0 mg/kg, respectively. The ACT values based on the HCP and HDR ACT obtained by two methods were compared with the actual ones directly measured from the patients. Results The ACT values in vivo measured by HCP presented a similarity with those in vitro obtained from the actual measurement （r = 0.62, 0.74; respectively; P 〈 0.05）. The HDR also showed a similarity with those in vitro obtained from the actual measurement （r = 0.66, 0.54, respectively; P 〈 0.05）. However, the values of HCP in vivo at 3.0 mg/kg was much closer to the actual values as compared with the HDR in vivo. Conclusion HCP is more accurate in predicting heparin dosage for extracorporeal circulation than HDR.

关 键 词：肝素 心脏手术 术后出血 浓度递进 

分 类 号：R654.2[医药卫生—外科学]