von Segesser L K, Garcia E, Turina M I
Clinic for Cardiovascular Surgery, University Hospital, Zürich, Switzerland.
Tex Heart Inst J. 1993;20(1):28-32.
Perfusion during cardiopulmonary bypass with low-dose heparin (activated clotting time, > 180 sec) versus full-dose heparin (activated clotting time, > 480 sec) combined with high-dose aprotinin was evaluated prospectively. Fifteen patients undergoing elective myocardial revascularization were randomly assigned to 1 of 2 groups. No significant differences between the groups were found for age, sex, body surface area, preoperative hematocrit level, duration of cardiopulmonary bypass, aortic cross-clamp time, mean number of bypasses per patient, or mean number of arterial grafts per patient. In all patients, heparin-coated cardiopulmonary bypass equipment was used, including heparinized hollow-fiber membrane oxygenators and tubing sets. In each group, protamine sulfate was given equivalent to the heparin loading dose; additional doses were administered according to the ACT. The mean total dosage of heparin was 9.5 +/- 1.4 x 10(3) IU for the group given low systemic heparinization (Group 1) compared with 34.6 +/- 3.4 x 10(3) IU for the group given full systemic heparinization in combination with high-dose aprotinin (Group 2) (p < 0.0001). The mean amount of aprotinin administered in Group 2 was 5.6 +/- 0.3 x 10(6) KIU; aprotinin was not used in Group 1. The mean protamine dosage necessary in Group 1, 7.0 +/- 0.9 x 10(3) IU, was significantly less than the 22.9 +/- 3.2 x 10(3) IU needed in Group 2 (p < 0.0001). In Group 1, shed blood recovery was achieved by a red-cell spinning device; in Group 2, cardiotomy suction was used. The total chest tube drainage (i.e., postoperative blood loss) per patient in Group 1 totaled 432 +/- 162 mL/m2; in Group 2, it was 311 +/- 111 mL/m2 (difference not significant). Transfusion requirements comprised a mean volume of 143 +/- 165 mL/m2 concentrated homologous red blood cells per patient in Group 1 and 416 +/- 128 mL/m2 in Group 2 (p < 0.01). Heparin-coated perfusion equipment allowed a significantly lower dosage of systemic heparin and protamine in Group 1 than that in Group 2, and a lower dosage in Group 2 than that in previous studies. Postoperative blood loss appeared to be similar between groups. The combination of heparin-coated perfusion equipment with low systemic heparinization and a red-cell spinning device provides promising results.
前瞻性评估了低剂量肝素（活化凝血时间>180秒）与全剂量肝素（活化凝血时间>480秒）联合高剂量抑肽酶在体外循环期间的灌注情况。15例接受择期心肌血运重建术的患者被随机分为两组。两组在年龄、性别、体表面积、术前血细胞比容水平、体外循环持续时间、主动脉阻断时间、每位患者平均搭桥数量或每位患者平均动脉移植物数量方面均未发现显著差异。所有患者均使用肝素涂层的体外循环设备，包括肝素化中空纤维膜氧合器和管路套件。每组均给予相当于肝素负荷剂量的硫酸鱼精蛋白；根据活化凝血时间给予额外剂量。低全身肝素化组（第1组）肝素的平均总剂量为9.5±1.4×10³IU，而全全身肝素化联合高剂量抑肽酶组（第2组）为34.6±3.4×10³IU（p<0.0001）。第2组抑肽酶的平均给药量为5.6±0.3×10⁶KIU；第1组未使用抑肽酶。第1组所需硫酸鱼精蛋白的平均剂量为7.0±0.9×10³IU，显著低于第2组所需的22.9±3.2×10³IU（p<0.0001）。第1组通过红细胞离心装置实现失血回收；第2组使用心内吸引。第1组每位患者的总胸管引流量（即术后失血量）总计为432±162mL/m²；第2组为311±111mL/m²（差异不显著）。输血需求量方面，第1组每位患者平均为143±165mL/m²浓缩同型红细胞，第2组为416±128mL/m²（p<0.01）。肝素涂层灌注设备使第1组的全身肝素和鱼精蛋白剂量显著低于第2组，且第2组的剂量低于以往研究。两组术后失血量似乎相似。肝素涂层灌注设备与低全身肝素化及红细胞离心装置的联合应用提供了有前景的结果。
