摘要
目的:探讨低剂量鱼精蛋白拮抗肝素围体外循环(CPB)期血浆肝素浓度变化的规律及其与术后凝血功能损害的关系。方法:采用发光底物法测定25例风湿性心脏瓣膜病瓣膜置换手术病人低剂量鱼精蛋白拮抗肝素下围CPB期血浆肝素浓度,并同时检测凝血功能指标:激活凝血时间(ACT)、血浆凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)。结果:CPB结束时血浆肝素平均水平(11.06U/mL)显著地降低到肝素化初期浓度(13.16U/mL)的0.84左右(P<0.05),低剂量鱼精蛋白拮抗肝素后5h内血浆肝素水平基本上稳定在CPB前水平(P>0.05);当鱼精蛋白中和肝素后,ACT值迅速接近至术前水平(P>0.05),并稳定于术前水平,而PT、APTT则仍显著异常高于正常水平(P<0.05),但有明显恢复至正常的趋势。结论:CPB结束时采用低剂量鱼精蛋白拮抗肝素(0.8mg鱼精蛋白∶100U肝素)能充分有效地中和血中肝素;CPB后凝血功能并不立即恢复正常,主要原因不是肝素中和不足,而是CPB本身使凝血功能受到损害。
Objective To investigate the change of plasma heparin concentration and relationship with blood coagulation dysfunction during and after cardiopulmonary bypass (CPB). Methods The plasma heparin concentrations with a factor Xa specific chromogenic substrate in laboratory under low dose protamine reversal of heparin during and after CPB in patients (n=25) with rheumatic valve disease undergoing valve replacement were measured. At the same time the coagulation indicators such as activated clotting time(ACT), prothrombin time( PT) and activated partial thromboplastin time(APTT) were detected.Results (1) At termination of CPB the mean plasma heparin concentration (11.06 U/mL) was significantly decreased to 0.84 of that (13.16 U/mL) at beginning of heparinilization(P< 0.05). Compared with that before CPB,the plasma heparin concentrations were almost stable in 5 hours after protamine reversal of heparin(P >0.05). (2) After protamine reversal of heparin, the ACTs were immediately closed to preoperative level(P >0.05) and stable, however, PT and APTT were still significantly longer(P< 0.05) than those before operation while there was an obvious tendency to normal.Conclusion The low dose protamine can neutralize anticoagulation effect of heparin sufficiently based on the ratio (0.8 mg protamine:100 U heparin). The main reason of coagulopathy following CPB is not insufficient protamine reversal of heparin, but the CPB itself.
出处
《实用医学杂志》
CAS
2005年第2期133-135,共3页
The Journal of Practical Medicine
