Wakefield T W, Lindblad B, Whitehouse W M, Hantler C B, Stanley J C
Surgery. 1986 Jul;100(1):45-51.
This investigation documented the effect of protamine sulfate pretreatment on the adverse hemodynamic and hematologic sequela of rapid intravenous protamine administration in heparinized dogs having undergone prior implantation of aortic prostheses. Fourteen dogs underwent infrarenal aortic replacement with 6 mm inner diameter by 7 cm knitted Dacron double-velour grafts. Carotid arterial, central venous, and pulmonary arterial catheters were placed for continuous hemodynamic monitoring. All dogs were adequately anticoagulated with heparin (150 IU/kg) and reversed with protamine (1.5 mg/kg/10 sec) after graft insertion. Pretreatment regimens studied included normal saline (n4), protamine 0.75 mg/kg (n5), and protamine 2.25 mg/kg in three divided doses of 0.75 mg/kg each (n5). All pretreatment agents were administered 3 minutes before heparinization. Blood pressure (BP), heart rate (HR), pulmonary artery pressure (PAP) and cardiac output (CO) were measured. Hematologic assessments included platelet count (PC), leukocyte count, thrombin clotting time, and total hemolytic complement. Significant salutory effects were associated with protamine pretreatment regarding BP, HR, PAP, CO, and PC. It is concluded that adverse hemodynamic effects of protamine reversal are blocked and certain hematologic effects are reduced with protamine pretreatment before heparinization and its reversal in this canine experimental model.
本研究记录了硫酸鱼精蛋白预处理对已植入主动脉假体的肝素化犬快速静脉注射鱼精蛋白后不良血流动力学和血液学后遗症的影响。14只犬接受了内径6mm、长7cm的针织涤纶双绒面移植血管的肾下主动脉置换术。放置颈动脉、中心静脉和肺动脉导管以进行连续血流动力学监测。所有犬在植入移植血管后均用肝素（150IU/kg）充分抗凝，并用鱼精蛋白（1.5mg/kg/10秒）进行中和。研究的预处理方案包括生理盐水（n = 4）、鱼精蛋白0.75mg/kg（n = 5）以及鱼精蛋白2.25mg/kg分三次给药，每次0.75mg/kg（n = 5）。所有预处理药物均在肝素化前3分钟给药。测量血压（BP）、心率（HR）、肺动脉压（PAP）和心输出量（CO）。血液学评估包括血小板计数（PC）、白细胞计数、凝血酶凝血时间和总溶血补体。鱼精蛋白预处理在BP、HR、PAP、CO和PC方面具有显著的有益作用。结论是，在该犬实验模型中，肝素化及其逆转前进行鱼精蛋白预处理可阻断鱼精蛋白逆转的不良血流动力学效应，并降低某些血液学效应。
