Matsushita Satoshi, Kishida Akinori, Wakamatsu Yoshihito, Mukaida Hiroshi, Yokokawa Hirohide, Yamamoto Taira, Amano Atsushi
Faculty of Medicine, Department of Cardiovascular Surgery, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
Department of Medical Engineer, Juntendo Hospital, Tokyo, Japan.
Gen Thorac Cardiovasc Surg. 2021 Jan;69(1):38-43. doi: 10.1007/s11748-020-01435-x. Epub 2020 Jul 12.
Initiation of cardiopulmonary bypass (CPB) for open-heart surgery requires that heparin be administered and reach an adequate value of activated clotting time (ACT). We previously introduced a new heparin formula that considered the preoperative ACT. In this study, we determined other factors affecting ACT.
Adult patients who underwent cardiac surgery using CPB were divided into two groups according to their ACT value after the initial administration of heparin during surgery. ACT above 450 s was defined as "Reach", and this group was compared to the "Short" group with ACT below 450 s.
The Reach and Short groups included 334 (64.7%) and 182 (35.3%) cases, respectively. Univariate analysis indicated that preoperative heparin use, age ≥ 80 years, New York Heart Association classification 4, white blood cell counts above the higher limit, hematocrit below the lower limit, platelet cell counts below the lower limit, low albumin levels, moderate renal dysfunction, high C-reactive protein levels, high brain natriuretic peptide levels, and moderate deterioration of left ventricular ejection fraction were associated with the effects of heparin. Multivariate analysis revealed that age ≥ 80 years (odds ratio [OR] 2.53, 95% confidence interval [95%CI] 1.41-5.24), New York Heart Association classification 4 (OR = 4.44, 95%CI 1.59-15.35), and platelet count below the lower limit (OR 0.37, 95%CI 0.31-0.85) were associated with the effects of heparin.
Old age, heart failure, and lower platelet counts affected heparin activity. The dose of heparin should be considered in those patients to reach the target ACT.
心脏直视手术开始体外循环（CPB）时需要给予肝素并使其活化凝血时间（ACT）达到适当值。我们之前引入了一种考虑术前ACT的新肝素配方。在本研究中，我们确定了影响ACT的其他因素。
接受CPB心脏手术的成年患者在手术期间首次给予肝素后，根据其ACT值分为两组。ACT高于450秒定义为“达到”组，该组与ACT低于450秒的“未达到”组进行比较。
“达到”组和“未达到”组分别包括334例（64.7%）和182例（35.3%）。单因素分析表明，术前使用肝素、年龄≥80岁、纽约心脏协会心功能分级4级、白细胞计数高于上限、血细胞比容低于下限、血小板计数低于下限、白蛋白水平低、中度肾功能不全、高C反应蛋白水平、高脑钠肽水平以及左心室射血分数中度下降与肝素效果相关。多因素分析显示，年龄≥80岁（比值比[OR]2.53，95%置信区间[95%CI]1.41 - 5.24）、纽约心脏协会心功能分级4级（OR = 4.44，95%CI 1.59 - 15.35）和血小板计数低于下限（OR 0.37，95%CI 0.31 - 0.85）与肝素效果相关。
老年、心力衰竭和较低的血小板计数影响肝素活性。对于这些患者，应考虑肝素剂量以达到目标ACT。
