Department of Anaesthesia, The Aga Khan University Hospital, Karachi, Pakistan.
J Coll Physicians Surg Pak. 2024 Nov;34(11):1275-1280. doi: 10.29271/jcpsp.2024.11.1280.
To assess the impact of post-protamine neutralisation activated clotting time (ACT) values on postoperative outcomes including chest drain output, transfusion requirements, and CICU stay, in patients undergoing cardiac surgery.
Observational comparative study. Place and Duration of the Study: Department of Anaesthesiology, The Aga Khan University Hospital, Karachi, Pakistan, from February to August 2023.
Ethical approval was obtained to collect data from elective cardiac surgery patients' charts. A sequential sampling approach analysed the baseline and post-protamine neutralisation ACT values, categorising patients into two groups. Group A maintained ACT within 10% of baseline, while Group B deviated. The outcomes measured included transfusion needs, chest drain output, additional protamine, cardiac intensive care unit (CICU) stay, and postoperative reopening. Statistical analysis included mean, median, frequency, t-test / Mann-Whitney U test, and Chi-square test.
The study comprised 101 patients (39 in Group A, 62 in Group B), with similar baseline health. No significant differences were found in tranexamic acid use, CICU stay, chest drain output, or transfusion rates between the groups (p >0.05).
Maintaining ACT within 10% of baseline post-protamine neutralisation results in similar intraoperative and postoperative outcomes, suggesting potential benefits in avoiding the aggressive protamine therapy and ensuring haemostasis in cardiac surgery.
Coronary Artery bypass grafting, Cardiopulmonary bypass, Activated clotting time (ACT), Heparin, Postoperative bleeding, Blood transfusions.
评估心脏手术后，鱼精蛋白中和后活化凝血时间（ACT）值对术后结果的影响，包括胸腔引流量、输血需求和心脏重症监护病房（CICU）住院时间。
观察性对比研究。研究地点和时间：巴基斯坦卡拉奇市阿迦汗大学医院麻醉科，2023 年 2 月至 8 月。
伦理批准后，从择期心脏手术患者的病历中收集数据。采用序贯抽样方法分析基线和鱼精蛋白中和后 ACT 值，将患者分为两组。A 组 ACT 维持在基线的 10%以内，B 组则偏离。测量的结果包括输血需求、胸腔引流量、额外的鱼精蛋白、CICU 住院时间和术后再开放。统计分析包括均值、中位数、频率、t 检验/曼-惠特尼 U 检验和卡方检验。
该研究共纳入 101 例患者（A 组 39 例，B 组 62 例），基线健康状况相似。两组在氨甲环酸使用、CICU 住院时间、胸腔引流量或输血率方面无显著差异（p＞0.05）。
鱼精蛋白中和后 ACT 维持在基线的 10%以内，可导致术中及术后结果相似，提示在心脏手术中避免过度使用鱼精蛋白治疗和确保止血可能具有潜在益处。
冠状动脉旁路移植术；体外循环；活化凝血时间（ACT）；肝素；术后出血；输血。
