Dalbert S, Ganter M T, Furrer L, Klaghofer R, Zollinger A, Hofer C K
Institute of Anaesthesiology and Intensive Care Medicine, Triemli City Hospital Zurich, Zurich, Switzerland.
Acta Anaesthesiol Scand. 2006 Apr;50(4):461-8. doi: 10.1111/j.1399-6576.2006.00990.x.
During cardiopulmonary bypass (CPB), measurement of kaolin-based activated clotting time (kACT) is a standard practice in monitoring heparin-induced anticoagulation. Despite the fact that the kACT test from the Sonoclot Analyzer (SkACT) has been commercially available for several years, no published data on the performance of SkACT are available. Thus, the aim of this in vitro study was to compare SkACT with an established kACT from Hemochron (HkACT).
Blood was withdrawn from 25 patients before elective cardiac surgery. SkACT and HkACT were measured in duplicate after in vitro administration of heparin (0, 1, 2 and 3 U/ml), calcium-free lactated Ringer's solution (25% and 50% haemodilution) and aprotinin (200 kIU/ml).
A total of 600 duplicate kACT measurements were obtained from 25 cardiac surgery patients. Overall, mean bias +/- SD between SkACT and HkACT was 7 +/- 70 s (1.3% +/- 14.1%). Administration of heparin, haemodilution and aprotinin induced a comparable effect on both activated clotting time (ACT) tests. Mean bias ranged from -4 +/- 39 s (-1.7% +/- 12.9%) to 4 +/- 78 s (3.2% +/- 15.6%) for heparinzed blood samples after haemodilution or aprotinin application and increased after combined aprotinin administration and haemodilution. After haemodilution and administration of aprotinin, both ACT tests were less reliable for values >480 s in heparinized blood samples.
Accuracy and performance of SkACT and HkACT were comparable after in vitro administration of heparin, aprotinin and haemodilution. Both ACT tests were considerably affected by aprotinin and haemodilution.
在体外循环（CPB）期间，基于高岭土的活化凝血时间（kACT）测量是监测肝素诱导抗凝的标准做法。尽管Sonoclot分析仪的kACT测试（SkACT）已上市数年，但尚无关于SkACT性能的公开数据。因此，本体外研究的目的是将SkACT与Hemochron公司的既定kACT（HkACT）进行比较。
在择期心脏手术前从25例患者中采集血液。在体外给予肝素（0、1、2和3 U/ml）、无钙乳酸林格氏液（25%和50%血液稀释）和抑肽酶（200 kIU/ml）后，对SkACT和HkACT进行重复测量。
从25例心脏手术患者中总共获得了600次重复的kACT测量值。总体而言，SkACT和HkACT之间的平均偏差±标准差为7±70秒（1.3%±14.1%）。肝素、血液稀释和抑肽酶的给予对两种活化凝血时间（ACT）测试产生了类似的影响。对于血液稀释或应用抑肽酶后的肝素化血样，平均偏差范围为-4±39秒（-1.7%±12.9%）至4±78秒（3.2%±15.6%），在联合应用抑肽酶和血液稀释后增加。在血液稀释和给予抑肽酶后，对于肝素化血样中>480秒的值，两种ACT测试的可靠性均降低。
在体外给予肝素、抑肽酶和血液稀释后，SkACT和HkACT的准确性和性能相当。两种ACT测试均受到抑肽酶和血液稀释的显著影响。
