新疆维吾尔族、新疆汉族和郑州汉族先天性心脏病患者心肺转流肝素化首次剂量的比较

The comparation of first dose of heparin of cardiopulmonary bypass in Xinjiang Uygur,Han and Zhengzhou Han patients with congenital heart disease

目的探讨新疆维吾尔族、新疆汉族和郑州汉族先天性心脏病患者心肺转流肝素化剂量的差异。方法于2011年3月至2014年3月从郑州大学第五附属医院收治的郑州汉族先天性心脏病行心内直视矫治术患者100例,从武汉亚洲心脏病医院新疆医院收治的新疆维吾尔族先天性心脏病行心内直视矫治术患者200例,新疆汉族心内直视矫治术患者100例作为研究对象,根据民族差异和地区分为:新疆维吾尔族(A组)200例,新疆汉族(B组)、郑州汉族(C组)各100例。A组依据首次肝素剂量不同分为两组,分别为A1组,给予肝素400 IU/kg(n=100),A2组,给予肝素500 IU/kg(n=100)。B组、C组均给予400 IU/kg肝素。四组术前均采集抗凝静脉血测定抗凝血酶Ⅲ(AT-Ⅲ)抗原含量。首次静脉注射肝素5 min后,测定并记录激活全血凝固时间(ACT)。ACT值<480 s视为肝素耐药。400 s<ACT<480 s时追加首次肝素剂量的一半;ACT<400 s时追加首剂全量,复查ACT>480 s方可转机。追加剂量仍然耐药(ACT<480 s)时输入新鲜冰冻血浆。记录肝素耐药比例、肝素化达标剂量(IU/kg)。结果术前AT-Ⅲ抗原含量测定,A1、A2组显著低于B、C两组(P<0.05)。首次注射肝素后,A1组17例(17.0%)ACT<480 s,其中11例(11.0%)ACT<400 s,肝素耐药比例明显高于其他三组,肝素化达标剂量明显高于B、C两组(P<0.05)。A2、B、C组肝素耐药比例差异无统计学意义,但A2组肝素化达标剂量明显高于其他三组(P<0.05)。结论新疆维吾尔族先天性心脏病患者发生肝素耐药性高于新疆汉族和郑州汉族患者,建议首次注射肝素化治疗时可调高剂量。

Objective To explore the first dosage of heparin of cardiopulmonary bypass in Xinjiang Uygur , Han and Zhengzhou Han patients with congenital heart disease .Methods From March 2011 to March 2014 ,100 Han patients with congenital heart disease underwent heart surgery from Fifth Affiliated Hospital of Zhengzhou University,200 Xinjiang Uighur patients with congenital heart disease underwent heart surgery from the hospital in Wuhan Asia Heart Hospital , 100 Han patients in Xinjiang underwent heart surgery as research subjects were enrolled in this study .According to ethnic and regional differences the patients were divided into Xinjiang Uygur group （group A,200 cases）,Xinjiang Han group （group B,100 cases）,and Zhengzhou Han group （group C,100 cases）.On the basis of the first dosage of heparin ,group A was divided into two different dosage of heparin （100 cases）：group A1 （400 IU/kg）,and group A2 （500 IU/kg）,respectively.The dosage of heparin was 400 IU/kg both in group B and C .Venous blood was exsanguinated to assay anticoagulant antithrombin Ⅲ （ AT-Ⅲ） antigen＆amp;nbsp;before the operation .Activate blood clotting time （ ACT ） was measured and recorded in 5 min after intravenous heparin in the first time.It was regarded as heparin resistance when the ACT value was less than 480 s.When the ACT value was between 400 s and 480 s,half-dosage heparin of first time should be appended ,while when the ACT value was less than 400 s,full-dosage heparin should be appended .Make sure the ACT value was more than 480 s before initiating cardiopulmonary bypass .Fresh frozen plasma should be infused when it was still resistance after the additional dosage .Heparin resistance ratio and standard heparin dosage （ IU/kg ） were recorded .Results The level of AT-Ⅲantigens before the operation in group A 1 and A2 was significantly lower than group B and C （ P〈0.05）.After the first injection of heparin,there were 17 patients in group A1 whose ACT value was less than 480 s, of which 11 cases＇ ACT value was less than 400 s.The rate of heparin resistance was significantly higher than the other three groups ,the standard dosage of heparin was significantly higher than group B and C （ P〈0 .05 ） , there were no statistically difference among Group A 2,B and C,but standard dosage heparin in group A 2 was significantly higher than the other three groups （P〈0.05）.Conclusion The occurrence of heparin resistance in patients with congenital heart disease in Xinjiang Uygur is higher than that in Xinjiang Han and Zhengzhou Han , in clinical treatment,we propose to increase the dosage heparin therapy for the first time .