Lango R, Mroziński P, Wujtewicz M, Suchorzewska J, Rogowski J, Narkiewicz M, Siebert J
Chair and Department of Anaesthesiology and Intensive Therapy, Medical University, Gdańsk, Poland.
Med Sci Monit. 2000 Jul-Aug;6(4):769-75.
Adverse effects of protamine administration after CPB: fall in arterial blood pressure and pulmonary hypertension are still a source of problems. CPB and protamine administration are both accompanied by increased histamine levels in blood. The aim of this study was to examine if clemastine can accelerate the normalisation of arterial blood pressure during the protamine administration after CPB during CABG operations.
Fifty three patients subjected to CABG operations were studied. Control group (n = 27) did not receive clemastine, Clemastine group (n = 26) received 2 mg i.v. clemastine, before CPB. After CPB were completed, patients were given protamine (heparin to protamine ratio--1:1.5) within 7 minutes, through peripheral vein. Changes in arterial blood pressure from the beginning of protamine administration to 2.5, 5, 7.5, 10, 15, and 30 minutes thereafter, as well as heart rate, CVP, doses of inotropic drugs and vasodilators were compared between the groups.
No difference in heart rate, CVP, doses of inotropic drugs and vasodilators between the group was noted. An increase in arterial blood pressure 5, 7.5, 10, and 15 minutes after the beginning of the protamine administration were greater in clemastine group than in control group. Groups were comparable with regard to surgical procedures and doses of anaesthetic drugs. It is now known that protamine exerts a negative effect on cardiac contractility either through a decrease in coronary perfusion pressure (vasodilatation), or through a direct toxic effect on cardiac muscle. The administration of clemastine before CPB can reduce peripheral vasodilatation and capillary leak related to histamine release during CPB. In the clemastine group, faster increase in arterial blood pressure toward a physiologic range was observed. We conclude that administration of clemastine is connected with the normalization of ABP during and after protamine reversal of heparin coagulation during CABG operations.
体外循环后注射鱼精蛋白的不良反应：动脉血压下降和肺动脉高压仍是问题所在。体外循环和注射鱼精蛋白均会伴随血液中组胺水平升高。本研究的目的是检验氯马斯汀是否能在冠状动脉搭桥手术（CABG）体外循环后注射鱼精蛋白期间加速动脉血压恢复正常。
对53例行CABG手术的患者进行研究。对照组（n = 27）未接受氯马斯汀，氯马斯汀组（n = 26）在体外循环前静脉注射2 mg氯马斯汀。体外循环完成后，患者在7分钟内通过外周静脉注射鱼精蛋白（肝素与鱼精蛋白比例为1:1.5）。比较两组从注射鱼精蛋白开始至其后2.5、5、7.5、10、15和30分钟时的动脉血压变化，以及心率、中心静脉压、强心药物和血管扩张剂的用量。
两组在心率、中心静脉压、强心药物和血管扩张剂用量方面无差异。氯马斯汀组在注射鱼精蛋白开始后5、7.5、10和15分钟时动脉血压的升高幅度大于对照组。两组在手术操作和麻醉药物用量方面具有可比性。现已知道，鱼精蛋白可通过降低冠状动脉灌注压（血管扩张）或对心肌的直接毒性作用对心脏收缩力产生负面影响。体外循环前注射氯马斯汀可减少与体外循环期间组胺释放相关的外周血管扩张和毛细血管渗漏。在氯马斯汀组中，观察到动脉血压更快地向生理范围升高。我们得出结论，在CABG手术中肝素凝血被鱼精蛋白逆转期间及之后，注射氯马斯汀与动脉血压恢复正常有关。
