肝素剂量反应曲线及肝素用量探讨

Study of the Dose-Response Curve and Recommonded Dose of Heparin in Patients with Congenital Heart Disease

目的计算非紫绀型先天性心脏病患儿群体化肝素剂量反应曲线及ACT(活化凝血时间)值达到480 s和750 s的最小肝素使用剂量。方法将68例非紫绀型先天性心脏病患儿随机分为六组,进入手术室后常规进行生命体征监测及麻醉,监测并记录生理ACT值。体外循环开始前对六组患儿分别静脉注射肝素钠0.5 mg/kg、1mg/kg、1.5 mg/kg、2 mg/kg、2.5 mg/kg、3 mg/kg,5min后采血监测并记录肝素后ACT值。记录每一位患儿的年龄、体重、身高、血常规、出凝血时间并计算体重指数。结果非紫绀型先天性心脏病患儿群体化肝素剂量反应曲线为ACT=190.38×每公斤体重肝素剂量+114.71(r=0.8991)。使95%的患儿ACT值达到480 s的肝素使用剂量为(1.92±0.13)mg/kg,ACT值达到750 s的肝素使用剂量为(3.34±0.26)mg/kg。结论非紫绀型先天性心脏病患儿ACT值达到480 s的肝素最小推荐使用剂量为2.05 mg/kg,ACT值达到750 s的肝素最小推荐使用剂量为3.60 mg/kg。

OBJECTIVE To draw the dose - reaction curve of heparin of congenital heart disease （CHD） patients and calculate the minimal heparin dose when actived clotting time （ACT） reached to 480 second and 750 second. METH- ODS Sixty- eight CHD patients were assigned randomly into six groups, monitoring and introduction as usual. Physiological ACT was monitored and recorded. Hepain was admitted to the six groups before cardiopulmonary bypass for the dose of 0.5mg/kg, 1 mg/kg, 1.5 mg/kg,2 mg/kg,2.5 mg/kg and 3 mg/kg, ACT was monitored after 300 seconds. The age, weight, height, RBC, Hgb, Hct, Plt, PT, APTT, TT and Fib of every patient were recorded. RESULTS The dose - response curve of heparin in CHD patients was ACT = 190.38 ×（ heparin dose per kg） ＋ 114.71 （ r = 0. 8991 ）. The heparin dose when the ACT of 95% CHD patients reached to 480 seconds and 750 seconds were 1.92±0.13mg/kg and 3.34± 0.26 mg/kg. CONCLUSION The minimal heparin dose of CHD patients when ACT reaches to 480 second and 750 second are 2.05 mg/kg and 3.60 mg/kg.