肝素个体敏感性与术后出血的相关性

Correlation between individual difference in heparin sensitivity and postoperative hemorrhage

目的探索在不同个体间肝素敏感性差异与术后出血之间的关系,为建立个体化肝素抗凝策略奠定基础。方法选择体外循环下实施心脏手术的患者共120例,术中测基础激活全血凝固时间(ACT),开胸骨后给予2.5 mg/kg首次肝素剂量,5 min后测ACT数值。根据首次肝素化后测得的ACT结果对患者进行分组,若ACT值达不到转机要求则继续追加肝素0.5 mg/kg,并分别记录各组术后出血量。记录患者的一般资料、输血量以及术后24 h引流量等资料。结果术后24 h胸腔引流量,3组数据之间差异有统计学意义(P<0.05),其中ACT>750 s组与ACT<480 s组明显高于ACT 480~750 s组,差异有统计学意义(P<0.05);ACT<480 s组与ACT>750 s组组间差异无统计学意义(P>0.05)。结论体外循环手术的患者肝素敏感性与术后出血具有相关性,其中ACT在480~750 s之间的患者出血量最低。

Objective To explore the relationship between individual difference in heparin sensitivity and postoperative bleeding, and lay the foundation for individualized heparin anticoagulant strategy. Methods A total of 120 patients undergoing cardiopulmonary bypass were enrolled in this study. Activated clotting time （ACT） of whole blood was established, and 2.5 mg/kg first heparin was given to the sternum. The value of ACT was measured after five minutes. The patients were divided into 3 groups according to the results of the first measured heparin. If the ACT value did not meet the transfer requirements, heparin 0.5 mg/kg was added, and the amount of bleeding was recorded. The general information of patients, blood transfusion and drainage and other information 24 hours postoperatively were recorded. Results Drainage volume 24 hours after the operation in 3 groups was statistically significant （P 〈 0.05 ）. Drainage volume 24 hours after the operation in group with ACT〉750 s and group with ACT〈d80 s was significantly higher than that in group with ACT ranging from 480 s to 750 s but the difference be- tween the group with ACT 〈 480 s and the group with ACT 〉 750 s was not statistieally significant （P 〉 0.05）. Conclusions Heparin sensitivity is associated with postoperative bleeding in patients with cardiopulmonary by- pass surgery, and patients with ACT ranging from 480 s to750 s have the lowest amount of bleeding.