Goto Shinya, Hiramori Tomoko, Kuroiwa Kaori, Mochizuki Noriaki, Takano Takahiro, Nishizawa Masaaki
Department of Anesthesia, Nagano Red Cross Hospital, Nagano 380-8582.
Masui. 2012 Apr;61(4):397-9.
Anesthetic Management of CABG in a Hemodialysis patient complicated by heparin-induced thrombocytopenia (HIT) type II is one of the different procedures in hemodialysis patients using heparin. An 81-year-old man receiving hemodialysis complicated by HIT type II was scheduled for coronary artery bypass grafting (CABG). Anesthesia was induced and maintained with propofol, remifentanil and rocuronium. During artificial cardiopulmonary bypass, activated clotting time (ACT) was maintained above 300 sec by in initial 0.1 mg x kg(-1) and subsequent 2.0-7.0 microg x kg(-1) x min(-1) doses of argatroban; a direct thrombin inhibitor. Immediately after the completion of the external cardiopulmonary circulation, continuous infusion of argatroban was discontinued. Seven hours later ACT was restored to the preoperative level. Both intra and postoperative courses were uneventful.
一名患有肝素诱导的血小板减少症（II型）的血液透析患者行冠状动脉旁路移植术（CABG）的麻醉管理是血液透析患者使用肝素时的不同操作之一。一名81岁接受血液透析且并发II型肝素诱导的血小板减少症的男性计划行冠状动脉旁路移植术（CABG）。麻醉诱导和维持采用丙泊酚、瑞芬太尼和罗库溴铵。在体外循环期间，通过初始剂量0.1mg/kg(-1)及随后2.0 - 7.0μg/kg(-1)·min(-1)的阿加曲班（一种直接凝血酶抑制剂）使活化凝血时间（ACT）维持在300秒以上。体外循环完成后立即停止阿加曲班持续输注。7小时后ACT恢复到术前水平。术中和术后过程均顺利。
