非体外循环冠状动脉旁路移植术期间肝素反应性：预测因素及临床意义。
Heparin responsiveness during off-pump coronary artery bypass graft surgery: predictors and clinical implications.
机构信息
Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Sungnam, Korea.
出版信息
Acta Pharmacol Sin. 2011 Jan;32(1):133-8. doi: 10.1038/aps.2010.180. Epub 2010 Dec 6.
AIM
To evaluate the clinical impact of reduced heparin responsiveness (HR(reduced)) on the incidence of myocardial infarction (MI) following off-pump coronary artery bypass graft surgery (OPCAB), and to identify the predictors of HR(reduced).
METHODS
A total of 199 patients scheduled for elective OPCAB were prospectively enrolled. During anastomosis, 150 U/kg of heparin was injected to achieve an activated clotting time (ACT) of ≥ 300 s, and the heparin sensitivity index (HSI) was calculated. HSIs below 1.0 were considered reduced (HR(reduced)). The relationships between the HSI and postoperative MI, cardiac enzyme levels and preoperative risk factors of HR(reduced) were investigated.
RESULTS
There was no significant relationship between the HSI and cardiac enzyme levels after OPCAB. The incidence of MI after OPCAB was not higher in HR(reduced) patients. HR(reduced) occurred more frequently in patients with low plasma albumin concentrations and high platelet counts.
CONCLUSION
HR(reduced) was not associated with adverse ischemic outcomes during the perioperative period in OPCAB patients, which seemed to be attributable to a tight prospective protocol for obtaining a target ACT regardless of the presence of HR(reduced).
目的
评估体外循环冠状动脉旁路移植术（OPCAB）后低肝素反应性（HR(reduced))对心肌梗死（MI）发生率的临床影响，并确定 HR(reduced)的预测因素。
方法
前瞻性纳入 199 例择期 OPCAB 患者。在吻合过程中，给予 150 U/kg 的肝素，以达到激活凝血时间（ACT）≥300s，并计算肝素敏感性指数（HSI）。低于 1.0 的 HSI 被认为是降低的（HR(reduced))。调查了 HSI 与术后 MI、心肌酶水平以及 HR(reduced)的术前危险因素之间的关系。
结果
OPCAB 后 HSI 与心肌酶水平之间无显著关系。HR(reduced)患者术后 MI 的发生率并不高。HR(reduced)在低血浆白蛋白浓度和高血小板计数的患者中更常见。
结论
HR(reduced)与 OPCAB 患者围手术期不良缺血结局无关，这似乎归因于无论 HR(reduced)是否存在，都严格采用前瞻性方案获得目标 ACT。
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