Isomatsu Y, Imai Y, Seo K, Terada M, Aoki M, Shin'oka T
Department of Pediatric Cardiovascular Surgery, Tokyo Women's Medical University, Japan.
Kyobu Geka. 2000 Nov;53(12):1001-4.
The Hepcon/HMS system automatically provides the activated clotting time and a whole blood heparin concentration. It also provides the adequate protamine dose by titration of protamine to heparin. 45 patients undergoing congenital heart surgery with cardiopulmonary bypass (CPB) were studied by the Hepcon/HMS device. We measured the heparin dose response before heparin administration, and the ration between the dose of protamine (ml) which was necessary for heparin neutralization at the termination of CPB and the dose of total heparin (ml) in each patient. The value of heparin dose response ranged 120-390 (mean 228) IU/kg. The ratio between protamine dose and heparin dose varied 0.11-0.99 (mean 0.55). There was a statistically significant correlation between the duration of CPB and this ratio (r = -0.51, n = 45, p = 0.0005). From the standpoint of variances in the value of heparin dose response, conventional way of the heparin administration according to the patient's body weight alone may cause inadequacy of anticoagulation during CPB. A dose of protamine determined by Hepcon device that is smaller than a conventional dose of protamine prevents inadvertent overdose and, therefore, can reduce the adverse effects excessive protamine has.
Hepcon/HMS系统可自动提供活化凝血时间和全血肝素浓度。它还通过将鱼精蛋白滴定至肝素，提供适当的鱼精蛋白剂量。我们使用Hepcon/HMS设备对45例接受体外循环（CPB）先天性心脏手术的患者进行了研究。我们在给予肝素前测量了肝素剂量反应，以及CPB结束时中和肝素所需的鱼精蛋白剂量（毫升）与每位患者总肝素剂量（毫升）之间的比值。肝素剂量反应值范围为120 - 390（平均228）IU/kg。鱼精蛋白剂量与肝素剂量的比值在0.11 - 0.99之间（平均0.55）。CPB持续时间与该比值之间存在统计学显著相关性（r = -0.51，n = 45，p = 0.0005）。从肝素剂量反应值的差异角度来看，仅根据患者体重的传统肝素给药方式可能导致CPB期间抗凝不足。由Hepcon设备确定的鱼精蛋白剂量小于传统鱼精蛋白剂量，可防止意外过量，因此可减少过量鱼精蛋白的不良反应。
