不同民族对肝素及鱼精蛋白作用的影响

A comparative study of role of heparin and protamine in cardiopulmonary bypass between uighurs and han race

目的手术后出血是患者进行体外循环心肺转流（CPB）术后的常见并发症,而肝素可防止CPB手术期间形成血栓,鱼精蛋白用于CPB结束后中和肝素而恢复正常凝血功能。因此,本文旨在探讨体外循环心内直视手术中不同民族对肝素及其拮抗剂鱼精蛋白作用的影响。方法选择60例拟行心内直视手术的成人患者,其中汉族30例,年龄18～52岁,平均年龄为（33.60±17.44）岁,男女性别比例为15∶15,体重38～67 kg,平均体重为（50.83±18.82）kg;维吾尔族患者30例,年龄19～57岁,平均年龄为（38.55±16.60）岁,男女性别比例为18∶12,体重41～70 kg,平均体重为（52.93±16.16）kg。2组患者在年龄、性别、体重、体外循环时间、心功能、血红蛋白、凝血酶原时间以及血小板计数方面等一般性资料经比较差异均无统计学意义（P〉0.05）,组间具有可比性。分别测定静注肝素5 min前ACT基础值、注射肝素5 min后ACT值,经鱼精蛋白（1∶1.5）拮抗后ACT值以及肝素总用量和鱼精蛋白总用量,运用t检验进行统计学分析。结果术前ACT基础值和经鱼精蛋白拮抗后ACT值在汉族和维吾尔族2组中比较,差异均无统计学意义;给予首次肝素（400 IU/kg）后,维吾尔族ACT值（374.30±58.88）明显低于汉族（719.45±137.81）,差异具有统计学意义（t=-27.993,P〈0.05）。维吾尔族肝素总用量（522.09±81.33）IU/kg明显高于汉族（400.08±60.05）IU/kg,差异具有统计学意义（t=-14.342,P〈0.05）,但鱼精蛋白总用量在2组间无明显差异。结论汉族患者肝素抗凝效果优于维吾尔族患者,鱼精蛋白中和作用与维吾尔族患者相当,为临床应用提供参考依据。

Objective The postoperative hemorrhage is the common complications after the cardiopulmonary bypass （CPB）. The heparin can prevent the formation of blood clots during CPB;however, protamine can play neutralization of heparin after CPB therefore restore normal blood clotting. The aim of this paper is to compare the role of heparin and pro- tamine in CPB between Uighurs and Han Race. Methods Sixty patients proposed to perform the open-heart surgery were enrolled in this study. 30 patients were Hart race ,age was 18 -52 with an average age of 33.60 ± 17.44 ,the male-female ratio was 15：15 ,weight was 38 -67 kg with an average weight （50.83 ± 18.82）kg;another 30 patients were Uighurs, age was 19 -57 with an average age of 38.55 ±16.60, the male-female ratio was 18： 12, weight was 41 -70 kg with an average weight （52.93± 16.16）kg. There was no statistical significant in age, gender, weight, cardiopulmonary bypass time, cardiac function, hemoglobin level, prothrombin time and blood platelet count （ P 〉 0.05 ） between the two groups. The baseline value of activated clotting time （ACT） 5 min before intravenous heparin and 5 min after intravenous heparin, and after the neutralization with protamine（ 1： 1.5 ） ,and the total dosage of heparin and protamine were all determined. T-test was used to perform the statistical analysis. Results The baseline value of ACT before the operation and after the neutralization with protamine was not significant statistical differences between the two groups. The ACT value of Uighurs 374.30 ±58.88 was significantly inferior to 719.45 ± 137.81 of Han race after the first administration of heparin（400 IU/kg）, the difference was significant （ t = - 27. 993, P 〈 0.05 ）. The total dosage （522.09 ± 81.33 ） IU/kg of heparin in Uighurs was higher than （400.08± 60.05 ） IU/kg of Han race, the difference was significant （ t = - 14. 342, P 〈 0.05 ） ; The total dosage of protamine was no significant statistical differences between two groups. Conclusion The anticoagulant effect of heparin in Han race is superior to that in Uighurs, and neutralization of heparin by protamine is similar between Han and Uighurs. This result provided a reference for the clinical application of heparin and protamine.