Lefemine A A, Lewis M
Am Surg. 1985 May;51(5):274-8.
Two groups of patients undergoing extracorporeal bypass were compared for heparin activity and for heparin and protamine dosage. In group I (18 patients), a uniform dosage pattern was neutralized at the end to a normal clotting time. In group II (43 patients), heparin and terminal protamine doses were regulated by activated clotting times (ACT) using a Hemochron (International Technidyne Corp., Metuchen, NJ). In group II there was a 39 per cent reduction of total heparin dose per case, protamine was reduced 76 per cent, and if the initial heparin doses were excluded, maintenance heparin was reduced 73 per cent. No pattern of heparin administration could be applied to all patients. Heparin half-life varied from 43 to 220 minutes. Other factors that alter heparin activity during bypass revealed no statistical differences. Plasma Hgb was significantly higher in group I, and platelet counts the day following operation were higher in group II. ACT allows tailoring heparin and protamine without the unnecessary dangers of variations in patient response and drug potency.
对两组接受体外循环的患者进行了肝素活性以及肝素和鱼精蛋白剂量的比较。在第一组（18例患者）中，采用统一的剂量模式，最终将凝血时间中和至正常。在第二组（43例患者）中，使用Hemochron（国际技术公司，新泽西州梅图申）通过活化凝血时间（ACT）来调节肝素和终末鱼精蛋白剂量。在第二组中，每例患者的肝素总剂量减少了39%，鱼精蛋白减少了76%，如果排除初始肝素剂量，维持肝素减少了73%。没有一种肝素给药模式可以适用于所有患者。肝素半衰期从43分钟到220分钟不等。其他在体外循环期间改变肝素活性的因素未显示出统计学差异。第一组的血浆血红蛋白显著更高，而第二组术后第一天的血小板计数更高。ACT允许调整肝素和鱼精蛋白的剂量，避免因患者反应和药物效力变化带来的不必要风险。
