心脏手术时患者肝素相对耐药原因的探讨

RELATIVE HEPARIN-RESISTANCE IN DIFFERENT TYPES OF CARDIAC SURGICAL PATIENTS

本文分病种观察了１１０例体外循环心脏手术患者肝素抗凝过程及血液化学检查，发现左房粘液瘤组患者的肝素用量居其它病种之首达４５７．２９Ｕ／ｋｇ，表现肝素相对耐药现象，而抗凝血酶ＩＩＩ（ＡＴＩＩＩ）含量明显低于其它各组，血小板计数高于其它组。本文提示肝素耐药的原因可能与ＡＴＩＩＩ水平低下和血小板计数偏高有关。

In order to clarify the relationship between heparin-resistance and different diseases, 110 patients undergone open heart operations were divided into five groups: group A(LAM) 20 cases, group B(ASD,VSD) 23 cases, group C (TOF) 22 cases, group D(RHD) 25 cases, and group E(CAD) 20 cases.Laboratory measurements involved were blood routine examination, prothrombin time (PT) before operation, and the content and activity of AT Ⅲ. An initial dose of 400 u/kg heparin was routinely given to all cases and a supplementary dose was given if ACT was shorter than 480 seconds before CPB.The total given dose of heparin and the pletelet count in group A were the highest among the five groups. The contents of AT Ⅲ before heparinization and after neutralization were 21. 05 ± 7. 66 mg/dl and 20. 44 ±5. 31 mg/dl. respectively in group A, which were not only lower than those of the other four groups (p<0. 01), but also below normal value (22-39 mg/dl) .It is concluded that the relative heparin-resistance in group A is related to its lower AT Ⅲ content and higher platelet count.