Xiong Jianqiu, Pan Tuo, Jin Hua, Xie Xiaoli, Wang Yan, Wang Dongjin
Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu, China.
Department of Cardio-Thoracic Surgery, Drum Tower Hospital Clinical Medical College of Nanjing Medical University, Nanjing, 210008, Jiangsu, China.
J Cardiothorac Surg. 2019 Feb 26;14(1):39. doi: 10.1186/s13019-019-0860-8.
Heparinized solution (HS) use for the maintenance of arterial cannulas has been associated with coagulation disorders and has not been conclusively shown to confer additional benefits over normal saline (NS) alone. We tested the hypothesis that in adult patients admitted to the cardiac ICU (T0) after cardiac surgery, HS arterial cannulas might be independently associated with increased heparin-induced coagulation disorders and might not be superior to NS arterial cannulas in reducing arterial cannula occlusion.
In this cohort study, 170 patients who received NS arterial cannulas during the period from T0 to ICU discharge were included in this study from June 1, 2017, to May 1, 2018 (NS group). There were 2930 patients who used HS (2.5 U/ml) arterial cannulas from January 1, 2015, to December 31, 2016 (heparin group). To address indicated biases, we derived a propensity score that predicted the functions of NS and HS in the patency of arterial cannulas.
There were 296 patients (148 in the NS group and 148 in the heparin group) with similar risk profiles in the propensity-score matched cohorts. In the propensity-matched patients, the duration of arterial cannulas (P = 0.4) and arterial cannula occlusion (P = 0.5) showed no differences between the NS and heparin groups. However, the heparin group had a significantly increased activated clotting time (P < 0.05), activated partial thromboplastin time (P = 0.01) and allogeneic red blood cell utilization (3.4% vs 10.8%, P < 0.05). Compared with the NS group, the heparin group had more drainage from chest tubes from T0 to T48 (10.6 ± 9.4 ml/kg vs 13.0 ± 7.22 ml/kg, P < 0.05) and had more allogeneic red blood cells transfused (0.1 ± 0.4 U vs 0.4 ± 1.1 U, P < 0.05).
Based on the results of our study, the addition of heparin to normal saline for flushing arterial pressure monitoring cannulae did not reduce the incidence of catheter thrombosis and result in a very small but statically significant in increase in activated clotting time and activated partial thromboplastin time.
使用肝素化溶液（HS）维持动脉插管与凝血功能障碍有关，并且尚未确凿表明其比单独使用生理盐水（NS）能带来更多益处。我们检验了这样一个假设：在心脏手术后入住心脏重症监护病房（T0）的成年患者中，HS动脉插管可能与肝素诱导的凝血功能障碍增加独立相关，并且在减少动脉插管堵塞方面可能并不优于NS动脉插管。
在这项队列研究中，2017年6月1日至2018年5月1日期间，170例在T0至重症监护病房出院期间接受NS动脉插管的患者被纳入本研究（NS组）。2015年1月1日至2016年12月31日期间，有2930例患者使用了HS（2.5 U/ml）动脉插管（肝素组）。为解决所指出的偏倚问题，我们得出了一个预测NS和HS在动脉插管通畅性方面作用的倾向评分。
在倾向评分匹配队列中，有296例患者（NS组148例，肝素组148例）具有相似的风险特征。在倾向匹配的患者中，NS组和肝素组之间的动脉插管持续时间（P = 0.4）和动脉插管堵塞情况（P = 0.5）没有差异。然而，肝素组的活化凝血时间（P < 0.05）、活化部分凝血活酶时间（P = 0.01）和异体红细胞使用率显著增加（3.4%对10.8%，P < 0.05）。与NS组相比，肝素组从T0到T48的胸管引流量更多（10.6±9.4 ml/kg对13.0±7.22 ml/kg，P < 0.05），并且输注的异体红细胞更多（0.1±0.4 U对0.4±1.1 U，P < 0.05）。
基于我们的研究结果，在生理盐水中添加肝素冲洗动脉压监测插管并未降低导管血栓形成的发生率，并且导致活化凝血时间和活化部分凝血活酶时间出现非常小但在统计学上有显著意义的增加。
