不同剂量肝素在体外循环心脏手术中应用的比较研究

Comparison of two heparin doses during cardiopulmonary bypass surgery

目的观察两种不同剂量的肝素在体外循环心脏手术的一系列相关指标的差异,以评估低剂量肝素用于该手术的临床应用效果。方法将60例需要体外循环(CPB)心脏外科手术的患者随机分成两组,分别采用2mg/kg(n=30)和3mg/kg(n=30)的初始肝素剂量,比较两组患者在术中和术后凝血功能、肝素化后活化凝血时间(ACT)、肝素总用量、鱼精蛋白量、微栓过滤网黏附度、术中和术后输血量、血小板数量、术后24h胸引量以及手术并发症等相关指标。结果 2mg/kg组(低剂量组)中有1例患者肝素化ACT未达400s,3mg/kg组(常规组)中ACT全部达到400s以上。两组患者术中及术后均无心梗、脑梗及肺栓塞等血栓栓塞并发症发生,微栓过滤器黏附度、术后输血量、血小板数量、术后24h胸引量等指标均无统计学差异(P>0.05)。相对于常规组,低剂量组的肝素化ACT较低(P<0.05),总肝素量、鱼精蛋白量和术中库血输入量明显减少(P<0.05)。2组在血浆凝血酶原时间(PT,CPB 20min和术后24h)、纤维蛋白原(Fib,CPB40 min和术后24h)指标上也存在差异(P<0.05)。结论与常规剂量肝素相比,采用低剂量肝素同样能使多数患者肝素化ACT值大于400s,满足体外循环手术需求,减轻凝血功能紊乱,并减少术中输血量。

Objective To observe a series of correlated index and to evaluate the effects of two heparin doses during cardiopulmonary bypass （CPB） surgery. Methods Sixty patients eligible for CPB surgery were divided randomly into low-dose heparin （2 mg/kg, n = 30） group and conventional heparin （3 mg/kg, n = 30 ） group. The function of blood coagulation during and after surgery, activated coagulation time （ACT） after injection of haparin, the total heparin doses, the protamine doses, the microembolus filter screen adhesion degrees, transfusion of allogeneic blood, platelet counts （PLT） , the amount of postoperative chest drainage at 24 h, mortality and morbidity were recorded for the two groups. Results In the low-dose heparin group, only one patient was unsuffieient to achieve target ACT while target ACT was achieved in all the patients of the conventional group. No eomplieation of myoeardial infaretion, cerebral and pulmonary embolism was detected in the patients during the operation and postoperation. There was no difference between the two groups in terms of the microembolus screen pack cleaning degree, postoperative blood transfusion, postoperative chest drainage at 24 h and platelet counts （PLT） , yet the ACT values after heparin administration of the low-dose heparin group was lower than the conventional group. The total heparin dose and the blood transfusion intraoperation were remarkably reduced in the low-dose group. The differences of prothrombin time （PT） at CPB20min and postoperative 24 h, fibrinogen （Fib） at CPB 40 min and postoperative 24 h in the two groups were significant. Conclusions Compared with conventional heparin （3 mg/ kg）, most patients in low dose heparin （2 mg/kg） can reach target ACT （400 s） after injection of initial heparin, meet the demand of CPB surgery, and also reduce blood coagulation disorders and blood transfusion intraoperation.