三个民族心脏手术患者肝素敏感性差异的临床研究

The clinic research of heparin sensitivity between different ethnic groups of the patients with heart surgery

目的 探讨三个民族体外循环心脏手术患者肝素敏感性及肝素用量的差异,为个体化用药奠定基础.方法 选择全身麻醉体外循环心脏手术患者共293例,其中维吾尔族（简称维族）109例,哈撒克族（简称哈族）86例,汉族98例,术中测基础激活全血凝固时间（ACT）,体外循环开始前首次给予肝素2 mg/kg,依次追加0.5 mg/kg肝素剂量至3.0 mg/kg,监测不同肝素剂量的ACT值.记录患者的一般资料、输血量以及术后24 h引流量.结果 不同民族间不同肝素剂量2.0、2.5、3.0 mg/kg下的ACT存在差异,维族、哈族患者较汉族明显增高,差异有统计学意义（P＜0.05）;不同民族2.0 mg/kg肝素剂量使ACT＞ 400 s所占人数比例的比较发现,维、哈、汉族分别为82.56％、84.88％、77.55％;不同民族术后24h出血量比较发现：维族、哈族较汉族明显减少（P＜0.05）,维族、哈族之间差异无统计学意义（P＞0.05）.结论 不同民族患者对同等肝素剂量的敏感性存在差异,汉族患者对肝素的敏感性较维族、哈族低,且术后出血量较多.

Objective To investigate heparin sensitivity and the difference of dosage of heparin during different ethnic groups of the patients with heart surgery.Methods Selecting 293 cases of patients with heart surgery under the general anesthesia extracorporeal circulation,included 109 cases of the Uighurs ethnic group,86 cases of Kazak ethnic group,98 cases of Han ethnic group.Detecting preoperative basis Activated Clotting Time （ACT）,giving heparin 2 mg/kg for the first time,adding heparin 0.5 mg/kg to 3.O mg/kg successively,monitoring the ACT of different doses of heparin,recorded the patients,general data,amount of blood transfusion and postoperative 24h flow.Results ACT is different under the different doses of heparin during different ethnic groups of the patients.The ACT of Uighur ethnic and Kazakh ethnic are higher than Han ethnic obviously,there is obvious statistical significance （P 〈 0.05） ; The comparison of the patients proportion of ACT 〉 400 s under heparin dose 2 mg/kg during different ethnic groups,Uighur ethnic,Kazakh ethnic and Han ethnic respectively accounted for 82.56%,84.88% and 77.55% ; To the postoperative 24 h flow,Uighur ethnic and Kazakh ethnic are less than Han ethnic obviously （P 〈 0.05）,but there is no significance between Uighur ethnic and Kazakh ethnic （P 〉 0.05）.Conclusion There is different sensitivity to the same dose of heparin during different ethnic groups.The sensitivity of heparin in Han ethnic patients is less than Uighur ethnic and Kazakh ethnic patients,and the postoperative blood loss is more than the other two groups.