Zhang Yufeng, Liu Kai, Li Wei, Xue Qian, Hong Jiang, Xu Jibin, Wu Lihui, Ji Guangyu, Sheng Jihong, Wang Zhinong
Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
J Cardiothorac Vasc Anesth. 2016 Oct;30(5):1179-83. doi: 10.1053/j.jvca.2016.04.005. Epub 2016 Apr 12.
To investigate the safety and efficacy of an adjusted regimen of heparin infusion in cardiopulmonary bypass (CPB) surgery in a Chinese population.
Prospective, single-center, observational study.
University teaching hospital.
Patients having cardiac surgery with CPB were selected for this study using the following criteria: 18 to 75 years of age, undergoing first-time cardiac surgery with conventional median sternotomy, aortic clamping time between 40 and 120 minutes, and preoperative routine blood tests showing normal liver, renal, and coagulation functions. The exclusion criteria include salvage cases, a history of coagulopathy in the family, and long-term use of anticoagulation or antiplatelet drugs.
Sixty patients were divided randomly into a control group (n = 30) receiving a traditional heparin regimen and an experimental group (n = 30) receiving an adjusted regimen.
Activated coagulation time (ACT) was monitored at different time points, ACT>480 seconds was set as the safety threshold of CPB. Heparin doses (initial dose, added dose, and total dose), protamine doses (initial dose, added dose, and total dose), CPB time, aortic clamping time, assisted circulation time, sternal closure time, blood transfusion volume, and drainage volume 24 hours after surgery were recorded. There was no significant difference in achieving target ACT after the initial dose of heparin between the 2 groups; CPB time, aortic clamping time, assisted circulation time, postoperative complication rate, and drainage volume between the 2 groups were not significantly different (p>0.05). However, initial and total dosage of heparin, initial and total dosage of protamine, sternal closure time, and intraoperative blood transfusion volume in the experimental group were significantly lower (p< 0.05).
Adjusted regimen of heparin infusion could be used safely and effectively in Chinese CPB patients, which might reduce the initial and total dosage of heparin and protamine as well as sternal closure time and intraoperative blood transfusion volume.
探讨调整后的肝素输注方案在我国人群体外循环（CPB）手术中的安全性和有效性。
前瞻性、单中心观察性研究。
大学教学医院。
采用以下标准选择接受CPB心脏手术的患者进行本研究：年龄18至75岁，首次行传统正中开胸心脏手术，主动脉阻断时间40至120分钟，术前常规血液检查显示肝、肾和凝血功能正常。排除标准包括挽救性病例、家族性凝血病病史以及长期使用抗凝或抗血小板药物。
60例患者随机分为对照组（n = 30）接受传统肝素方案和试验组（n = 30）接受调整后的方案。
在不同时间点监测活化凝血时间（ACT），将ACT>480秒设定为CPB的安全阈值。记录肝素剂量（初始剂量、追加剂量和总剂量）、鱼精蛋白剂量（初始剂量、追加剂量和总剂量）、CPB时间、主动脉阻断时间、辅助循环时间、胸骨关闭时间、术后24小时输血量和引流量。两组在肝素初始剂量后达到目标ACT方面无显著差异；两组之间的CPB时间、主动脉阻断时间、辅助循环时间、术后并发症发生率和引流量无显著差异（p>0.05）。然而，试验组肝素的初始剂量和总剂量、鱼精蛋白的初始剂量和总剂量、胸骨关闭时间和术中输血量显著更低（p<0.05）。
调整后的肝素输注方案可安全有效地用于我国CPB患者，这可能会减少肝素和鱼精蛋白的初始剂量和总剂量以及胸骨关闭时间和术中输血量。
