导管室中应用达肝素时抗凝活性的监测

Laboratory Monitoring of Intravenously Administered Dalteparin in the Cardiac Catheter room

目的:本研究旨在探讨激活凝血时间(ACT)是否可作为达肝素在导管室中应用时有效的抗凝监测手段.方法:共人选108例患者,冠状动脉造影(CAG)术前5min一次静脉注射达肝素60IU/kg,术中不再追加抗凝药物.所有患者均在静脉注射达肝素后5min取血测量ACT.其中30例患者作为抗凝活性检测组分别在达肝素注射前和注射后6个时间点取血检测抗凝参数ACT、aPTT、抗Xa因子和抗IIa因子活性,观察静脉注射达肝素后的时间-抗凝效应关系.结果:静脉注射达肝素后5minACT值由基线121s升高到193s,10min时达峰值208s,并持续120min无明显下降(P<0.001).aPTT、血浆抗Xa和抗IIa因子活性也呈类似趋势.结论:ACT和aPTT对静脉注射达肝素敏感.ACT可以用来监测PCI期间静脉注射达肝素的抗凝活性.

Objective： To determine whether the activated clotting time （ACT） may act as an effective monitoring method after intravenous low - molecular - weight - heparin （LMWH） dalteparin used in cardiac catheterization. Methods： A total of 108 patients were treated with intravenous dalteparin 60IU/kg at 5 minutes before coronary angiography （CAG） without additional bolus of LMWH or unfractionated heparin （UFH） during percutaneous coronary intervention （PCI）. 45 patients （41.7%） underwent immediate PCI. ACT was tested in all patients at 5 minutes after Ⅳ dalteparin. Blood samples were taken among 30 patients for measurement of ACT, activated partial thromboplastin time （aPTT）, plasma anti - Xa and anti - HⅡ levels respectively at the different time to observe anticoagulant time - effect relationship. Results：5 minutes after administration of intravenous dalteparin, the ACT increased from 121 s to 193 s, rised to peak value 208 s at 10 min, and sustained to 120 min without significant decrease （P 〈 0.001）. The aFTT, anti - Xa and anti - Ⅱa activities also demonstrated significant increases following Ⅳ dalteparin. Conclusion：The ACT and aFTT are sensitive to intravenous dalteparin. The ACT may be useful in monitering the anticoagulant effect of intravenously administered dalteparin during PCI.