Mabry C D, Thompson B W, Read R C
Am J Surg. 1979 Dec;138(6):894-900. doi: 10.1016/0002-9610(79)90318-0.
We conclude that (1) the activated clotting time (ACT) is an accurate method of monitoring anti-coagulation during peripheral vascular surgery and can easily be performed by a technician in the operating room or at the bedside; (2) an initial heparinizing dose of 120 to 130 units/kg is adequate in 95 per cent of the patients; (3) the ACT should be maintained at greater than twice the control values (180 to 200 seconds), which required supplementation within 2 hours in 21 per cent; (4) the response to heparin is twofold: an initial sensitivity or resistance followed by an independent and variable rate of consumption; (5) the patient's heparin dose-response curve should be used to calculate the amount of supplemental heparin needed to maintain the ACT at a safe level; (6) protamine should be given if the ACT at the conclusion of the operation is greater than 150 seconds (50 per cent of our patients); and (7) a final ACT 15 to 30 minutes postoperatively should be obtained to ensure adequate reversal or to detect heparin rebound or depletion of clotting factors.
（1）活化凝血时间（ACT）是外周血管手术期间监测抗凝情况的准确方法，技术人员可在手术室或床边轻松操作；（2）95%的患者初始肝素化剂量为120至130单位/千克就足够；（3）ACT应维持在对照值（180至200秒）的两倍以上，21%的患者需要在2小时内补充肝素；（4）对肝素的反应有两方面：最初的敏感性或抵抗性，随后是独立且可变的消耗率；（5）应使用患者的肝素剂量反应曲线来计算将ACT维持在安全水平所需补充的肝素量；（6）如果手术结束时ACT大于150秒（我们50%的患者），应给予鱼精蛋白；（7）术后15至30分钟应获取最终ACT，以确保充分逆转或检测肝素反弹或凝血因子消耗。
