Yoshida Tomohiko, Matsuura Katsuhiro, Mandour Ahmed S, Aboshi Yuki, Yamada Shusaku, Yotsuida Hideki, Hasegawa Mizuki, Cheng Chieh-Jen, Yaginuma Youta, Watanabe Momoko, Fukuzumi Shou
VCA Japan Shiraishi Animal Hospital, 4-33-2 Sayamadai, Sayama, Saitama 350-1304, Japan.
Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu 183-0054, Tokyo, Japan.
Vet Sci. 2022 Apr 8;9(4):178. doi: 10.3390/vetsci9040178.
Protamine, an antagonizing agent to heparin, is indispensable for dogs undergoing cardiopulmonary bypass. Protamine-induced hypotension (PIH) during cardiac anesthesia has been reported in humans. The purpose of this study was to describe the hemodynamic effect of protamine administration in dogs during cardiac surgery in clinical cases. Study design: Retrospective, clinical, cohort study. A total of 14 client-owned dogs who suffered heart failure due to medically uncontrolled myxomatous mitral valve disease (MMVD) were included in this study. The severity of MMVD was classified according to American College of Veterinary Internal Medicine staging (ACVIM: stage B2, C, D) and dogs undergoing mitral valve surgery. Records with clinical data for dogs treated between July 2019 to August 2020 were examined for age, sex, breed, body weight, concurrent diseases, hospitalization, anesthetic record, and mortality within 3 months after the operation. PIH was defined as mean arterial pressure (MAP) lowered by 20% of that before protamine infusion. To evaluate the effect of protamine on hemodynamic variables, each of the other values was compared with values at the beginning of protamine infusion. MAP decreased by 41.0 and 45.7% in two dogs (14.3%) compared with pressure before protamine infusion. Others did not show obvious alteration in hemodynamic variables. Epinephrine treatment alleviated hypotension in one dog. Another dog with systemic hypotension concomitant with elevated central venous pressure did not respond to epinephrine treatment and a reboot of extracorporeal circulation was required. Reheparinization and reinstitution of cardiopulmonary bypass successfully resuscitate the second dog. In conclusion, clinicians should alert the incidence of severe hypotension even with slow protamine infusion following canine cardiac surgery. This study also provides two effective treatments for catastrophic hypotension during protamine infusion.
鱼精蛋白是肝素的拮抗剂，对于接受体外循环的犬类来说必不可少。人类中曾有关于心脏麻醉期间鱼精蛋白诱导性低血压（PIH）的报道。本研究的目的是描述临床病例中犬类心脏手术期间注射鱼精蛋白的血流动力学效应。研究设计：回顾性临床队列研究。本研究纳入了14只因药物治疗无法控制的黏液瘤性二尖瓣疾病（MMVD）而患心力衰竭的客户-owned犬。根据美国兽医内科学会分期（ACVIM：B2期、C期、D期）对MMVD的严重程度进行分类，并纳入接受二尖瓣手术的犬。检查了2019年7月至2020年8月期间治疗犬的临床数据记录，包括年龄、性别、品种、体重、并发疾病、住院情况、麻醉记录以及术后3个月内的死亡率。PIH定义为平均动脉压（MAP）降低至鱼精蛋白输注前的20%。为评估鱼精蛋白对血流动力学变量的影响，将其他每个值与鱼精蛋白输注开始时的值进行比较。与鱼精蛋白输注前的压力相比，两只犬（14.3%）的MAP分别降低了41.0%和45.7%。其他犬的血流动力学变量未显示明显变化。肾上腺素治疗缓解了一只犬的低血压。另一只伴有全身低血压且中心静脉压升高的犬对肾上腺素治疗无反应，需要重启体外循环。再次肝素化和恢复体外循环成功挽救了第二只犬。总之，临床医生应警惕犬类心脏手术后即使缓慢输注鱼精蛋白也可能发生严重低血压。本研究还提供了两种治疗鱼精蛋白输注期间灾难性低血压的有效方法。
