体外肝素浓度递进法预测心脏手术患者肝素有效剂量的临床研究

摘要

目的 本研究探索肝素剂量曲线(HDR)和体外肝素浓度递进(HCP)两种预测肝素初始剂量的方法,评估HCP对心脏手术患者精准肝素用量的预测价值.方法 纳入18~65岁择期行心脏手术的患者,在手术开始之前抽取颈静脉血进HCP(2.5、3.0 mg/kg)试验;手术过程中经颈静脉首次给予肝素2 mg/kg,然后每隔5分钟每次追加肝素0.5 mg/kg直至总量达到2.5、3.0 mg/kg,并分别测ACT值且使ACT≥480 s;根据HDR计算出每位患者2.5、3.0 mg/kg的ACT值;分别根据HCP和HDR两种方法所得到的ACT值与实际体内所测得相对应的值进行比较.结果 将HDR和HCP两种方法所测得ACT值与体内相应剂量的ACT值进行比较发现:体外HCP与体内相应浓度的肝素实测ACT值之间有较好相似性(r值分别为0.62和0.74),P<0.05;HDR与体内相应浓度肝素的实测ACT值之间也有较好相似性(r分别为0.66和0.54), P<0.05;但HDR和HCP与体内实际的结果比较发现,体外HCP的预测结果特别是3.0 mg/kg与体内实测值相似度更高.结论 HCP相对于HDR法预测满足体外循环所需抗凝效果的肝素剂量方面有较高的准确性.%Objective This study explored two methods of predicting the initial dose of heparin by heparin dose response curve(HDR)and in vitro heparin concentration progressive(HCP),and evaluated the predictive value of HCP for precise heparin dosage in patients undergoing cardiac surgery. Method Include 18-65 years old undergoing elective cardiac surgery patients,Before the start of the surgery internal jugular vein blood was taken in-to the HCP(2.5 mg/kg,3.0 mg/kg)test;The first injection of heparin 2 mg/kg via the internal jugular vein, then every 5 minutes each additional heparin 0.5 mg/kg to amount to 2.5 mg/kg,3.0 mg/kg,and measurement ACT and until ACT value≥480 s;According to HDR calculated per patient 2.5,3.0 mg/kg of ACT value;Respective-ly according to the HCP and HDR ACT values obtained by two methods with the actual measured by the correspond-ing value in the body. Results Comparing the ACT values measured by HDR and HCP with the corresponding ACT values in vivo:There are good similarity for heparinization ACT value between HCP and the actual body corresponding concentrations(r was 0.62 and 0.74,respectively),P<0.05;HDR results also have better similar-ity(r was 0.66 and 0.54,respectively),P < 0.05;However,HDR and HCP compared with the actual results in vivo found that in vitro HCP prediction results especially 3.0 mg/kg is more similar with the actual values.Conclu-sions HCP for predicting heparin dosage to meet extracorporeal circulation is more accurate.