Ichikawa Junko, Kodaka Mitsuharu, Nishiyama Keiko, Hirasaki Yuji, Ozaki Makoto, Komori Makiko
Department of Anesthesiology, Tokyo Women's Medical University Medical Center East.
Department of Anesthesiology, Tokyo Women's Medical University Medical Center East.
J Cardiothorac Vasc Anesth. 2014 Aug;28(4):1003-7. doi: 10.1053/j.jvca.2013.10.010. Epub 2014 Feb 5.
The Hepcon Heparin Management System (HMS) facilitates administration of higher heparin and lower protamine doses, which may affect bleeding potential due to heparin rebound. The present study evaluated heparin rebound in patients for whom the Hepcon HMS was used to determine whether point-of-care tests detect residual heparin and residual heparin is associated with postoperative blood loss.
Prospective study.
Tertiary care center affiliated with a university hospital.
Adults undergoing elective cardiac surgery requiring cardiopulmonary bypass.
In blood samples obtained at baseline, at 2 minutes, and at 1, 2, 4, 6, and 24 hours after heparin neutralization, heparin concentrations were measured using an automated chromogenic assay. Activated coagulation time (ACT), activated partial thromboplastin time (APTT), and thromboelastometry 2 hours after heparin neutralization also were examined in the last 22 study patients enrolled.
All 31 patients had measurable heparin levels 2 hours after protamine administration; 22 patients exhibited a primary failure to reverse heparin after protamine administration, and 9 patients had measureable heparin levels 2 hours after complete heparin reversal (ie, heparin rebound). The thromboelastometric variable, INTEM-CT:HEPTEM-CT ratio, correlated with heparin concentration (r=0.72), but ACT (r=-0.12), APTT (r=0.36), and whole blood heparin concentration, determined using the Hepcon HMS, did not. Peak heparin concentration (0.18±0.07 U/mL) at 4 hours was not correlated with mediastinal blood loss.
Circulating heparin detected by the chromogenic assay was too low to be clinically significant based on postoperative bleeding, although all 31 patients had residual heparin or heparin rebound at 2 hours after protamine administration with use of the Hepcon HMS.
Hepcon肝素管理系统（HMS）有助于使用更高剂量的肝素和更低剂量的鱼精蛋白，这可能因肝素反跳而影响出血风险。本研究评估了使用Hepcon HMS的患者的肝素反跳情况，以确定即时检验是否能检测到残余肝素，以及残余肝素是否与术后失血有关。
前瞻性研究。
一所大学医院附属的三级医疗中心。
接受需要体外循环的择期心脏手术的成年人。
在基线、2分钟时以及肝素中和后1、2、4、6和24小时采集的血样中，使用自动显色测定法测量肝素浓度。在最后纳入研究的22例患者中，还检测了肝素中和后2小时的活化凝血时间（ACT）、活化部分凝血活酶时间（APTT）和血栓弹力图。
所有31例患者在注射鱼精蛋白后2小时均有可测量的肝素水平；22例患者在注射鱼精蛋白后出现肝素逆转原发性失败，9例患者在肝素完全逆转后（即肝素反跳）2小时有可测量的肝素水平。血栓弹力图变量INTEM-CT:HEPTEM-CT比值与肝素浓度相关（r = 0.72），但ACT（r = -0.12）、APTT（r = 0.36）以及使用Hepcon HMS测定的全血肝素浓度与之无关。4小时时的峰值肝素浓度（0.18±0.07 U/mL）与纵隔失血无关。
尽管所有31例使用Hepcon HMS的患者在注射鱼精蛋白后2小时均有残余肝素或肝素反跳，但显色测定法检测到的循环肝素水平过低，基于术后出血情况无临床意义。
