氯化钙预防鱼精蛋白不良反应临床观察

Clinical Observation of Calcium Chloride’s Protection Effect on Protamine’s Untoward Reaction

目的鱼精蛋白中和肝素所引起的不良反应是心脏体外循环(cardiopulmonary bypass,CPB)常见并发症之一,探寻有效治疗药物减轻鱼精蛋白不良反应是近年来的研究热点。文中分析及探讨体外循环中鱼精蛋白毒性反应的特点及防治措施,观察用氯化钙预防鱼精蛋白不良反应的效果。方法选择体外循环心内直视手术40例随机分为氯化钙组(观察组)A组和(对照组)B组,每组20例。观察组术中以5%氯化钙5ml加等渗氯化钠稀释硫酸鱼精蛋白至50ml中和肝素,对照组不加氯化钙用等渗氯化钠稀释硫酸鱼精蛋白至50ml,两组中和液均用微量输液泵经升主动脉30分钟注完。观察两组注药前及后1、3、5、10、20min的血压、心率、中心静脉压和气道压力变化。结果 A组注药前后血压、心率、中心静脉压和气道压力变化差异无统计学意义(P>O.05);B组有6例注药后出现血压、心率明显下降,中心静脉压和气道压上升(P<0.05)。结论氯化钙能明显减少或缓解硫酸鱼精蛋白中和肝素所引起的不良反应。

Objective protamine＇ s untoward reaction in neutralizing heparin is one of frequent complications during cardiopulmonary bypass （CPB）,and searching for effective therapeutic drugs to attenuate protamine＇ s untoward reaction is a research hotspot in recent years.This study aims to study the characteristics and management of adverse reaction to protamine during open heart operation under cardiopulmonary bypass （CPB） and investigate precaution effect of calcium chloride on protamine,s untoward reaction. Methods Forty patients scheduled to have open heart operation under cardiopulmonary bypass （CPB） were randomly divided into two groups： calcium chloride group （group A, n=20） and the control group （group B, n =20）. In both groups 50ml solution mixed with protamine and isotonic sodium chloride was injected through the ascending aorta over twenty minutes to neutralize the effect of heparin. In group A, 5% calcium chloride 5ml was added into the 50ml heparin neutralization solution; while in group B no calcium chloride was added. Arterial pressure （AP）, heart rate （HR）, CVP and airway resistance（Paw） were measured before injection and 1, 3, 5, 10 20minutes after injection in both groups. Results In group A, the AP, HR , CVP and Paw had no significant difference before and after injection （P〉0. 05）; while in 6 cases of group B, the AP, HR, CVP and AR had significant differences before and after injection, with decreased AP, HR CVP and increased Paw （P〈0. 05）. Conclusion Calcium chloride can significantly reduce protamine＇ s untoward reaction in neutralizing the effect of heparin.