Mertzlufft F, Koster A, Hansen R, Risch A, Kuppe H, Kübel B, Crystal G J
Klinik fuer Anaesthesiologie und Intensivmedizin, Universitaetskliniken des Saarlandes, D-66421 Homburg-Saar, Germany.
Anesthesiology. 2000 Jun;92(6):1594-602. doi: 10.1097/00000542-200006000-00016.
The authors assessed the heparin management test in vitro in volunteers and in vivo during cardiopulmonary bypass.
In vitro, the heparin management test was analyzed for heparin levels between 0 and 6 IU/ml using variations in hematocrit, platelets, procoagulants, and storage time. The in vivostudies consisted of two groups: In group I (cardiopulmonary bypass </= 90 min, n = 40), anticoagulation was performed according to the activated clotting time (with or without aprotinin); in group II (cardiopulmonary bypass >/= 180 min, with aprotinin) included use (n = 10) and nonuse of coumadin (n = 10) and anticoagulation according to the automated heparin dose-response assay. Tests were performed in duplicate (whole blood, two heparin management test analyzers) and compared with anti-Xa activity (plasma).
In vitro, the results of the heparin management test (n = 1,070) correlated well with heparin concentration (r2 = 0.98). Dilution and storage time did not affect the heparin management test; a hematocrit of 60% and reduced procoagulants (10%) prolonged clotting time. In vivo, the correlation (heparin management test vs. anti-Xa) was strong in group I (r2 = 0.97 [with aprotinin] and 0.96 [without aprotinin]; n = 960) and group II without coumadin (r2 = 0.89, n = 516). In group II with coumadin, the overall correlation was r2 = 0.87 and 0.79 (n = 484), although the range varied widely (0.57-0.94, between-analyzer differences 0-47%).
The results of the heparin management test were influenced by hematocrit, plasma coagulation factors, and the heparin level, but not by use of aprotinin. The heparin management test provided reliable values in vitro in group I, and in group II without coumadin but was less reliable in group II with coumadin.
作者在志愿者中进行了体外肝素管理测试，并在体外循环期间进行了体内测试。
在体外，使用血细胞比容、血小板、促凝剂和储存时间的变化，分析了肝素水平在0至6 IU/ml之间的肝素管理测试。体内研究包括两组：第一组（体外循环≤90分钟，n = 40），根据活化凝血时间进行抗凝（使用或不使用抑肽酶）；第二组（体外循环≥180分钟，使用抑肽酶）包括使用（n = 10）和不使用香豆素（n = 10），并根据自动肝素剂量反应测定进行抗凝。测试一式两份进行（全血，两台肝素管理测试分析仪），并与抗Xa活性（血浆）进行比较。
在体外，肝素管理测试结果（n = 1070）与肝素浓度相关性良好（r2 = 0.98）。稀释和储存时间不影响肝素管理测试；血细胞比容为60%和促凝剂减少（10%）会延长凝血时间。在体内，第一组（r2 = 0.97[使用抑肽酶]和0.96[不使用抑肽酶]；n = 960）和第二组不使用香豆素时（r2 = 0.89，n = 516），肝素管理测试与抗Xa之间的相关性很强。在使用香豆素的第二组中，总体相关性为r2 = 0.87和0.79（n = 484），尽管范围差异很大（0.57 - 0.94，分析仪间差异0 - 47%）。
肝素管理测试结果受血细胞比容、血浆凝血因子和肝素水平影响，但不受抑肽酶使用的影响。肝素管理测试在第一组体外以及第二组不使用香豆素时提供了可靠的值，但在使用香豆素的第二组中可靠性较低。
