Hashimoto K, Sasaki T, Hachiya T, Takakura H, Onoguchi K, Nagahori R, Takeuchi S
Department of Cardiovascular Surgery, Saitama Ohara Cardiovascular Center, Japan.
J Cardiovasc Surg (Torino). 1999 Oct;40(5):645-51.
A heparin/protamine titration system for measurement of heparin levels (Hepcon) is promising for efficient anticoagulation during cardiopulmonary bypass (CPB).
Fifty-seven patients subjected to CPB were divided into two groups, control (n = 24) and Hepcon groups (n = 33). The Hepcon group was further divided into three subgroups according to perfusion temperature. For the control group, conventional administration of an anticoagulant (300 IU/kg of heparin) and reversal protocol (heparin 1: protamine 1) was performed. For the Hepcon group, a heparin dose-response assay directed the initial dose of heparin. Hepcon also determined the dose of protamine by the titration. The initial dose of heparin in the control group (300 IU/kg) was statistically less than that of Hepcon group (360+/-80 IU/kg).
In the Hepcon group, the sensitivity to heparin was correlated with coagulation time (r = -0.78) and antithrombin III levels (r = 0.70), and individual difference of sensitivity resulted in a wide range of dosage (160 to 490 IU/kg). A strong correlation was observed between plasma and whole blood concentration of heparin (r = 0.86). However, they did not correlate with ACT values. Perfusion temperature didn't affect the heparin level, but did the ACT value. In the Hepcon group, the dose of protamine was significantly less and adverse events were rare.
In conclusion, whole blood heparin measurements correlated well with plasma heparin concentration. Protamine titration of heparin reduced the dose of protamine and decreased the chance of adverse reactions.
用于测量肝素水平的肝素/鱼精蛋白滴定系统（Hepcon）有望在体外循环（CPB）期间实现有效的抗凝。
57例接受CPB的患者被分为两组，对照组（n = 24）和Hepcon组（n = 33）。Hepcon组根据灌注温度进一步分为三个亚组。对于对照组，采用常规抗凝剂给药（300 IU/kg肝素）和逆转方案（肝素1：鱼精蛋白1）。对于Hepcon组，通过肝素剂量反应测定法确定肝素的初始剂量。Hepcon还通过滴定确定鱼精蛋白的剂量。对照组肝素的初始剂量（300 IU/kg）在统计学上低于Hepcon组（360±80 IU/kg）。
在Hepcon组中，对肝素的敏感性与凝血时间（r = -0.78）和抗凝血酶III水平（r = 0.70）相关，敏感性的个体差异导致剂量范围较宽（160至490 IU/kg）。观察到肝素的血浆浓度与全血浓度之间有很强的相关性（r = 0.86）。然而，它们与活化凝血时间（ACT）值无关。灌注温度不影响肝素水平，但影响ACT值。在Hepcon组中，鱼精蛋白的剂量明显较少，不良事件也很少见。
总之，全血肝素测量与血浆肝素浓度密切相关。肝素的鱼精蛋白滴定减少了鱼精蛋白的剂量并降低了不良反应的发生几率。
