心脏手术患者肝素抵抗:病例报道及文献回顾  

Heparin Resistance in Patients Undergoing Cardiac Surgery:Case report and Literature Review

作　　者：邵恳 何丽仙 姚允泰[1] 陆海松[1,3] 袁素 李立环[1] SHAO Ken;HE Li-xian;YAO Yun-tai;LU Hai-song;YUAN Su;LI Li-huan(Department of Anesthesiology,Fuwai Hospital,CAMS,PUMC,National Center for Cardiovascular Disease,Beijing 100037,China;Department of Anesthesiology,Jingmen No.1 People's Hospital,Jingmen,Hubei 448000,China;Department of Anesthesiology,PUMCH,CAMS,PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院国家心血管病中心,阜外医院麻醉中心,北京市100037 [2]荆门市第一人民医院麻醉科,荆门市448000 [3]中国医学科学院,北京协和医学院北京协和医院麻醉科,北京市100730

出　　处：《中国分子心脏病学杂志》2019年第6期3140-3145,共6页Molecular Cardiology of China

摘　　要：目的总结心脏手术患者肝素抵抗的原因及处理。方法检索中国知网、万方数据、维普网、中国生物医学网和PUBMED等数据库以获取相关文献下载全文并提取信息。结果最后纳入24篇相关病例报道,其中男性17例,女性16例(共33例患者)。特殊情况1例机械瓣故障行二次阻断,1例氧合器里有血凝块立即更换氧合器及动静脉管道。2例ACT不达标手术取消。3例死亡(分别因脑梗、肺脓肿感染、心肌梗死)。24例手术后痊愈。结论肝素抵抗患者体外循环期间应严密监测ACT值变化,特别在复温后肝素代谢快,更应引起重视。Objective To summarize the causes and management of heparin resistance in patients undergoing cardiac surgery.Methods A systematic literature search was conducted in the databases such as CNKI,Wanfang Data,CQVIP,SinoMed and PUBMED to retrieve relevant documents and extract information.Results A total of 33 patients in 24 relevant case reports were ultimately enrolled,including 17 males and 16 females.In special circumstances,1 case of mechanical valve failure was secondary blocked,and 1 case of blood clot in the oxygenator was replaced immediately with a new oxygenator and Arterial and venous ducts.2 cases was cancelled due to the substandard ACT.1 case died of cerebral infarction,pulmonary abscess infection and infarction respectively.24 cases recovered after surgery.Conclusion The change of ACT value should be closely monitored in heparin resistant patients during CPB(cardiopulmonary bypass),especially after the rewarming time of rapid metabolism of heparin,which should be paid more attention to.

关 键 词：心脏手术 肝素抵抗 病例报道 回顾性分析 

分 类 号：R654.2[医药卫生—外科学]