Bulbul Ziad R, Galal Mohammed Omar, Mahmoud Elsayed, Narden Bettina, Solymar Laszlo, Chaudhary Mohammad Ashraf, Al Halees Zohair Y
Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Asian Cardiovasc Thorac Ann. 2002 Jun;10(2):129-32. doi: 10.1177/021849230201000208.
We sought to determine if a higher dose of heparin would reduce arterial complications in patients weighing 10 kg or less undergoing cardiac catheterization to investigate congenital heart disease. Sixty patients were given either 100 (group A) or 150 (group B) IU x kg(-1) of heparin in a double-blinded randomized manner. Initial arterial access was established using a 4F cannula in all patients. Mean activated clotting time measured 20 minutes following heparin administration was significantly lower in group A than in group B (199 versus 251 seconds). Only 3 out of 60 patients (5%) required treatment for loss of femoral pulse. The age, weight, activated clotting time, length of catheterization procedure, time taken to establish arterial access, and the duration of arterial cannulation were comparable between the groups. Weight under 4 kg, age under 1 month, and cannula size larger than 4F were identified as independent risk factors for the development of arterial complications. Arterial access using a 4F cannula is a safe procedure in children weighing 10 kg or less. The incidence of significant arterial complications is low, and they do not appear to be preventable by a higher dose of heparin.
我们试图确定，对于体重10千克及以下接受心脏导管插入术以检查先天性心脏病的患者，更高剂量的肝素是否会减少动脉并发症。60名患者以双盲随机方式分别接受100（A组）或150（B组）IU×kg⁻¹的肝素。所有患者均使用4F套管建立初始动脉通路。肝素给药后20分钟测得的平均活化凝血时间，A组显著低于B组（199秒对251秒）。60名患者中只有3名（5%）因股动脉搏动消失需要治疗。两组之间的年龄、体重、活化凝血时间、导管插入术时长、建立动脉通路所需时间以及动脉插管持续时间具有可比性。4千克以下的体重、1个月以下的年龄以及大于4F的套管尺寸被确定为发生动脉并发症的独立危险因素。对于体重10千克及以下的儿童，使用4F套管进行动脉通路建立是一种安全的操作。严重动脉并发症的发生率较低，而且更高剂量的肝素似乎无法预防这些并发症。
