应用血栓弹力图探讨不同比例鱼精蛋白中和肝素对体外循环心脏手术后出凝血的影响  

Effect of different ratios of protamine to neutralizing heparin on bleeding and clotting after cardiopulmo-nary bypass using thromboelastography

作　　者：杨洋[1] 宋辛叶 栾永[2] YANG Yang;SONG Xinye;LUAN Yong(Dalian Medical Universi-ty,Dalian 116041,China;不详)

机构地区：[1]大连医科大学,辽宁大连116041 [2]大连医科大学附属第一医院麻醉科,辽宁大连116011

出　　处：《实用医学杂志》2020年第21期2926-2930,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金(编号:31971243)。

摘　　要：目的在常规监测激活全血凝固时间(activated clotting time,ACT)的基础上,应用血栓弹力图(thrombelastography,TEG),对比体外循环心内直视手术中常用鱼精蛋白与肝素中和比例对出凝血的影响。方法按鱼精蛋白与初始肝素剂量比例随机分为4组:0.6、0.8、1.0、1.3,每组25例。分别记录ACT及TEG值、肝素残留率、术后引流量、鱼精蛋白不良反应等。结果(1)四组术后引流量差异无统计学意义。(2)0.6组中和后TEG参数呈恶化趋势,与1.3组差异有统计学意义。(3)肝素残留与鱼精蛋白比例有关,0.6组残留率最高。(4)组内肝素高残留与无残留患者引流量相比,差异有统计学意义。结论鱼精蛋白与肝素比例≤0.8时,肝素残留率较高,出血风险增加。比例为1.0及1.3时,肝素残留率低,未见凝血功能明显损害,出血风险小。Objective To compare the effects of different ratios of protamine to heparin neutralization commonly used in cardiopulmonary bypass(CPB)on coagulation by using thromboelastography(TEG)on the basis of activated clotting time of whole blood(ACT).Methods According to the dose ratio of protamine to initial heparin,patients were randomly divided into 0.6,0.8,1.0 and 1.3 group,with 25 cases in each group.ACT and TEG values,heparin residual rate,postoperative drainage,and protamine adverse reactions in each group were recorded and compared.Results(1)There was no significant difference in postoperative drainage of the four groups.(2)TEG parameters of the 0.6 group showed a worsening trend after neutralization,which was statistically different from those of the 1.3 group.(3)The residual heparin was related to the proportion of protamine,and the residual rate in the 0.6 group was the highest.(4)The drainage of patients with high residual heparin and that ofpatients without residual in the same group indicated statistical difference.Conclusions When the ratio of protamine to heparin is≤0.8,the residual rate of heparin is higher,and the bleeding risk increases accordingly.When the ratio is 1.0 or 1.3,the residual rate of heparin is low,and there is no obvious damage to the coagulation function,and the risk of bleeding is low.

关 键 词：血栓弹力图 鱼精蛋白 肝素 凝血 

分 类 号：R654.2[医药卫生—外科学]