Akl B F, Vargas G M, Neal J, Robillard J, Kelly P
J Thorac Cardiovasc Surg. 1980 Jan;79(1):97-102.
The clinical experience with the activated clotting time (ACT) for the control of heparin and protamine therapy during cardiopulmonary bypass in 70 patients (50 adults and 20 children) is reviewed. After a standard dose of 2 mg/kg of body weight of heparin, the patient's ACT ranged from 210 to more than 600 seconds. The heparin dose required to accomplish an ACT of 500 seconds ranged from 1.3 to 4.7 mg/kg for adults and from 2 to 4.5 mg/kg for children. At the termination of bypass, the assessment of the patient's heparin level with the ACT allowed a more accurate reversal with protamine and markedly reduced the protamine requirements. Although the postoperative drainage was not significantly decreased, the total amount of blood transfusion and fresh-frozen plasma and platelet requirements were reduced by 30%, 20%, and 20% respectively. The simple, easy-to-use protocol is presented in detail.
回顾了70例患者（50例成人和20例儿童）在体外循环期间使用活化凝血时间（ACT）控制肝素和鱼精蛋白治疗的临床经验。给予标准剂量2mg/kg体重的肝素后，患者的ACT范围为210秒至600多秒。使成人ACT达到500秒所需的肝素剂量为1.3至4.7mg/kg，儿童为2至4.5mg/kg。在体外循环结束时，通过ACT评估患者的肝素水平可更准确地用鱼精蛋白进行逆转，并显著减少鱼精蛋白的用量。虽然术后引流量没有显著减少，但输血量、新鲜冰冻血浆用量和血小板用量分别减少了30%、20%和20%。详细介绍了这个简单易用的方案。
