Friesen R H, Clement A J
J Thorac Cardiovasc Surg. 1976 Dec;72(6):875-9.
It has been proposed that wide variations in individual response to heparin lead to deficiencies in popular heparinization protocols for extracorporeal circulation (ECC). Thirty-nine patients undergoing open cardiac operations with ECC were anticoagulated with the heparinization protocol in use at St. Thomas' Hospital. The coagulation state was monitored with the blood activated recalcification time (BART) test. Wide variations in heparin dose-response and heparin activity-decay curves were observed. No patient was underheparinized, but many had markedly prolonged BART's. The total dose of heparin declined because BART monitoring allowed elimination of incremental heparin doses up to 180 minutes of ECC. Adequate reversal with protamine was achieved in all patients regardless of response to herparin. Alternative approaches for heparinization for ECC can be developed with the aid of rapid tests of the intraoperative coagulation state.
有人提出，个体对肝素的反应差异很大，这导致了体外循环（ECC）常用肝素化方案存在缺陷。39例接受心脏直视手术并进行ECC的患者，按照圣托马斯医院正在使用的肝素化方案进行抗凝。采用血液激活复钙时间（BART）试验监测凝血状态。观察到肝素剂量反应和肝素活性衰减曲线存在很大差异。没有患者肝素化不足，但许多患者的BART明显延长。肝素总剂量下降，因为BART监测允许在ECC长达180分钟时取消递增的肝素剂量。所有患者无论对肝素的反应如何，用鱼精蛋白都能实现充分的逆转。借助术中凝血状态的快速检测，可以开发ECC肝素化的替代方法。
