心内直视手术中应用小剂量鱼精蛋白的临床效果

Study of clinical effect of small dose protamine during open heart surgery

目的探讨心内直视手术中小剂量(0.33～0.67∶1)鱼精蛋白中和肝素的临床结果。方法361例心内直视手术使用小剂量鱼精蛋白中和肝素为实验组,87例心内直视手术使用鱼精蛋白1.5∶1的比例中和肝素为对照组,比较两组鱼精蛋白用量、术后引流量、中和后的ACT值、鱼精蛋白毒性反应发生率。结果小剂量组术后引流量及二次开胸的发生率均低于对照组(P<0.05),术中和术后的ACT值两组无差异(P>0.05),但实验组鱼精蛋白的用量、鱼精蛋白毒性反应发生率均低于对照组(P<0.01)。结论小剂量鱼精蛋白0.33～0.67∶1(鱼精蛋白/肝素)可有效地中和肝素,防止术后引流量增多,降低鱼精蛋白毒性反应的发生。

[Objective] To evaluate the elinieal effeet of small dose protamine （0.33-0.6：1） applied in open heart surgery. [Methods] All the eases was divide into two groups. The experimental group inelude 361 eases whieh were applied small dose protamine to neutralize heparin in open heart surgery, and the eontrel group inelude 87 eases whieh were applied protamine aeeording to 1：1 proportion, then eompare their postoperative drainage quantity, the dose of protamine, the ACT value after neutralization and the toxieity reaetion of protamine. [Result] The postoperative drainage quantity and re-operative rate in experimental group were lower remarkably than that of the eontrol group （P 〈0.05）. The ACT value after neutralization had no differenee between the two groups （P 〉0.05）. But the dosage and the toxieity reaetion rate of protamine in experimental group obviously lower than that of the eontrel group （P 〈0.01）. [Conclusion] Small dose protamine 0.33-0.67：1 （protamine/heparin） ean neutralize effeetively heparin, reduee the postoperative drainage quantity, and reduee fundamentally the toxieity reaetion rate of protamine.