Inoue S, Miyashita T, Kuro M
Department of Anesthesiology, National Cardiovascular Center, Suita.
Masui. 1997 Jul;46(7):987-90.
A 71-year-old female was scheduled for the re-replacement of a mechanical mitral valve. After the cardiopulmonary bypass (CPB) she was administered protamine sulfate. Subsequently mean systemic blood pressure went down below 20 mmHg and central venous pressure and mean pulmonary blood pressure were above 50 mmHg, and immediately CPB was restarted as an assist device for circulation. After the second CPB, she was administered protamine sulfate again, and the same shock occurred. At last the third CPB was restarted and the third protamine administration was not undertaken after the third CPB. Although her postoperative drainage may have been relatively much more compared with cases of neutralization of heparin, postoperative course was uneventful in this patient. Administered protamine to neutralize the anticoagulat effects of heparin may often cause temporary treatable hypotension. Although protamine may rarely cause severe pulmonary vasocontriction and anaphylactoid reactions, clinical pictures become critical once these reactions occur. It is important in these cases to identify protamine as the cause of shock and avoid repeating the shocks.
一名71岁女性计划进行机械二尖瓣再次置换术。体外循环（CPB）后，她接受了硫酸鱼精蛋白治疗。随后，平均体循环血压降至20 mmHg以下，中心静脉压和平均肺血压高于50 mmHg，立即重新启动CPB作为循环辅助装置。第二次CPB后，她再次接受硫酸鱼精蛋白治疗，出现了相同的休克情况。最后第三次重新启动CPB，第三次CPB后未进行第三次鱼精蛋白给药。尽管与肝素中和的病例相比，她术后的引流量可能相对较多，但该患者术后病程平稳。用于中和肝素抗凝作用的硫酸鱼精蛋白给药常常可能导致暂时性可治疗的低血压。尽管硫酸鱼精蛋白可能很少引起严重的肺血管收缩和类过敏反应，但一旦这些反应发生，临床情况就会变得危急。在这些病例中，重要的是确定鱼精蛋白是休克的原因并避免再次发生休克。
