CABG术中ACT、CR监测方法的比较

The comparation of the methods of monitoring ACT and CR during CABG

目的冠状动脉旁路移植术（coronary artery bnypassgraft，CABG）围术期常规监测激活凝血时间（activated clottingtime，ACT）和纤维蛋白原（Fibrinogen，Fbg）。通过使用Sonoclot凝血功能分析仪（sonoclot coagulationanalyzer，SCA）与传统凝血检测的ACT（conventional ACT test，c-AcT）和Fbg进行相关性分析，对CABG术中ACT、CR监测方法进行比较。方法选择非体外循环（Off-ump）CABG患者18例（OP组），体外循环（cardiopulmonary bypass，CPB）CABG患者12例（CPB组），分别于诱导后（T0）、首次给肝素（OP组0．8mg／kg，CPB组1．0mg／kg）后5min（T1），追加肝素（0P组达1．5mg／kg，CPB组达3．0mg／kg）后5min（T2），鱼精蛋白中和肝素后5min（T3）4个时间点，取中心静脉血同时测定C-ACT和SCA的3种ACT及CR。结果①T0点，SonACT、kACT、aiACT分别与C-ACT正相关，相关方程分别为：y=83．15＋0．37×（R=0．438，P〈0．05）；y=71．33＋0．43×（R=0．509，P〈0．01）；y=56．19＋0．78×（R=0．790，P〈0．01）。sonCR、kCR、aiCR与术前Fbg正相关，相关方程分别为：y=1．16＋0．09×（R=0．821，P〈0．001）；y=1．11＋0．09×（R=0．773，P〈0．001）；y=1．50＋0．06×（R=0．882，P〈0．001）。②T3点与T0点相比，C-ACT差异有统计学意义（P〈0．01），sonACT、kACT、aiACT差异均无统计学意义。③给予低剂量肝素0，8mg／kg和1.0mg／kg时，分别有39％和83％患者C-ACT大于300S，而sonACT大于300s的例数达55％和95％，kACT则是55％和100％；CR的下降值（ACR）占基础值的百分比已达74％-76％和76％-83％。结论①SCA3种ACT与C-ACT正相关性比较：aiACT〉kACT〉sonACT，aiACT相关性最好；cR与Fbg正相关性比较：aiCR〉sonCR〉kCR，aiCR相关性最好。②鱼精蛋白中和肝素后，SCA3种ACT比C-ACT恢复更好。③使用SCA与传统检测相比能够在低剂量肝素（0．8mg／kg-1．0mg／kg）时更敏感地监测ACT和CR。

Objective Activated clotting time （ACT）and fibrinogen （Fbg） are regularly monitored during Coronary Artery Bypass Graft（CABG）. We got the results of ACT and CR by using Sonoclot coagulation analyzer（SCA） to canpare with conventional ACT test （C-ACT）and Fbg, and discussed the differences among the various methods of monitoring ACT and CR duning CABG. Methods 30 patients undergoing CABG were divided into 2 groups, off-pump CABG group（OP, n=18）and cardio-pulmonary bypass CABG group （CPB, n=12）. Blood samples were collected through C-line to dertermine the value of C-ACT and sonACT, kACT, aiACT, sonCR, kCR and aiCR after induction （T0）, 5 minutes after presenting heparin （0.8 mg/kg in OP group, 1.0 mg/kg in CPB group）（Ti）, 5 minutes after adding heparin （added to 1.5 mg/kg in OP group, 3.0 mg/kg in CPB group）（T2）, 5 minutes after heparin neutralization with protamine（T3）. Results ① At point T0, the baseline of the three ACT of SCA all correlates with C mg/kgACT, the correlating equations are y=83.15 ＋0.37 ×（R =0.438, P〈0.05 ）, y=71.33 ＋0.43 ×（R =0.509, P〈0.01 ）, y=56.19 ＋0.78 ×（R =0.790, P〈 0.01 ）, respectively. And the CRs all correlates with Fbg, the correlating equations are y=1.16＋0.09×（R=0.821, P〈0.001）;y=1.11＋ 0.09x（R=0.773, P〈0.001 ）;y=1.50＋0.06×（R=0.882, P〈0.001 ）, respectively. ② There is significant difference between To and T3 on the results of C-ACT, P〈0.01, but not the SCA resuhs. ③ When the dose of heparin is low of 0.8mg/kg or1.0mg/kg, the percent of the patients whose C-ACT higher than 300 seconds is 39% or 83%, and whose sonACT and kACT higher than 300 seconds is 55% or more than 92%. The percent of the decrement of CR is 74%-76% or 76%-83%. Conclusion ①The comparation of the correlation： aiACT〉kACT〉SonACT, aiCR〉sonCR〉kCR, So both of aiACT and aiCR are more accruate than the others. ② After heparin neutralization, the recovery of the SCA results are better than C-ACT.③SCA is more sensitive than C-ACT when the dose of heparin is low such as 0.8 mg/kg-1.0 mg/kg.