Levy J H, Schwieger I M, Zaidan J R, Faraj B A, Weintraub W S
Emory University School of Medicine, Division of Cardiothoracic Anesthesiology, Atlanta, Ga.
J Thorac Cardiovasc Surg. 1989 Aug;98(2):200-4.
Patients with neutral protamine Hagedorn and protamine-zinc insulin-dependent diabetes, a history of fish allergy, or prior vasectomy have been reported to be at an increased risk for protamine reactions after cardiopulmonary bypass because of prior sensitization. We prospectively evaluated cardiac surgical patients with prior vasectomies and fish allergies and retrospectively evaluated a cohort of 3245 consecutive cardiac surgical patients requiring cardiopulmonary bypass over a 2-year period for protamine-containing insulin use and clinical evidence of adverse reactions after protamine administration for heparin reversal after cardiopulmonary bypass. Clinical reactions to protamine did not occur in six patients with fish allergies or 16 patients with prior vasectomies. There was one reaction (0.6%) in 160 patients with neutral protamine Hagedorn insulin-dependent diabetes. The incidence of clinical reactions in the other patients was 2/3085 (0.06%). The incidence of clinical reactions in the patients with neutral protamine Hagedorn insulin-dependent diabetes is not significantly different from that in other patients. We conclude that prior neutral protamine Hagedorn insulin use, a history of fish allergy, or prior vasectomy does not represent a contraindication to protamine administration after cardiopulmonary bypass.
据报道，使用中效鱼精蛋白锌胰岛素的糖尿病患者、有鱼过敏史或既往接受过输精管切除术的患者，由于先前的致敏作用，在体外循环后发生鱼精蛋白反应的风险增加。我们前瞻性评估了有既往输精管切除术和鱼过敏史的心脏外科手术患者，并回顾性评估了一组在两年期间连续3245例需要体外循环的心脏外科手术患者，以了解含鱼精蛋白胰岛素的使用情况以及体外循环后使用鱼精蛋白逆转肝素后出现不良反应的临床证据。6例有鱼过敏史的患者和16例有既往输精管切除术的患者未发生对鱼精蛋白的临床反应。160例使用中效鱼精蛋白锌胰岛素的糖尿病患者中有1例出现反应（0.6%）。其他患者的临床反应发生率为2/3085（0.06%）。使用中效鱼精蛋白锌胰岛素的糖尿病患者的临床反应发生率与其他患者无显著差异。我们得出结论，既往使用中效鱼精蛋白锌胰岛素、有鱼过敏史或既往接受过输精管切除术并不代表体外循环后使用鱼精蛋白的禁忌证。
