Ocal Ahmet, Kiriş Ilker, Erdinç Melih, Peker Oktay, Yavuz Turhan, Ibrişim Erdoğan
The Department of Cardiovascular Surgery, School of Medicine, Süleyman Demirel University, Isparta, Turkey.
Tohoku J Exp Med. 2005 Sep;207(1):51-8. doi: 10.1620/tjem.207.51.
Protamine is used after cardiopulmonary bypass was stopped in order to reverse the anticoagulant effects of heparin administered during open-heart operations. Adverse hemodynamic responses to protamine are common, ranging from minor perturbations to cardiovascular collapse. The aim of the present study was to investigate whether a prostacyclin is effective in the treatment of protamine-mediated acute pulmonary hypertension and right ventricular failure in the perioperative period of isolated coronary artery bypass grafting (CABG) operations. In sixty-eight (1.78%) of 3800 patients who underwent isolated CABG, acute pulmonary hypertension and right ventricular failure developed during or following the protamine infusion. These 68 patients were included in the study and were randomized into two groups. Thirty-eight of the patients received prostaglandin I(2) (PGI(2)), norepinephrine and dopamine (PGI(2) group), whereas 30 patients received nitroglycerin, norepinephrine and dopamine (control group). Hemodynamic data were recorded before and after the above drug combinations. The mean value of left ventricle ejection fraction significantly increased (p < 0.05) and mean values of central venous pressure, pulmonary artery systolic and diastolic pressure, pulmonary capillary wedge pressure and pulmonary vascular resistance significantly decreased (p < 0.05) in the PGI(2) group. The mean value of pulmonary capillary wedge pressure significantly decreased (p < 0.05) and the mean value of central venous pressure significantly increased (p < 0.05) in the control group. In conclusion, prostacyclin (PGI(2)) is effective in the treatment of protamine-mediated acute pulmonary hypertension and right ventricular failure in the perioperative period in isolated CABG operations. This finding may be an important contribution to the treatment of severe protamine complications during open-heart operations.
在体外循环停止后使用鱼精蛋白，以逆转心脏直视手术期间给予肝素的抗凝作用。鱼精蛋白引起的不良血流动力学反应很常见，从轻微紊乱到心血管崩溃不等。本研究的目的是调查前列环素是否能有效治疗孤立性冠状动脉旁路移植术（CABG）围手术期鱼精蛋白介导的急性肺动脉高压和右心室衰竭。在3800例接受孤立性CABG的患者中，有68例（1.78%）在鱼精蛋白输注期间或之后出现急性肺动脉高压和右心室衰竭。这68例患者被纳入研究并随机分为两组。38例患者接受前列腺素I(2)（PGI(2)）、去甲肾上腺素和多巴胺（PGI(2)组），而30例患者接受硝酸甘油、去甲肾上腺素和多巴胺（对照组）。记录上述药物组合前后的血流动力学数据。PGI(2)组左心室射血分数平均值显著增加（p<0.05），中心静脉压、肺动脉收缩压和舒张压、肺毛细血管楔压和肺血管阻力平均值显著降低（p<0.05）。对照组肺毛细血管楔压平均值显著降低（p<0.05），中心静脉压平均值显著增加（p<0.05）。总之，前列环素（PGI(2)）在治疗孤立性CABG围手术期鱼精蛋白介导的急性肺动脉高压和右心室衰竭方面是有效的。这一发现可能对心脏直视手术期间严重鱼精蛋白并发症的治疗有重要贡献。
