不同剂量鱼精蛋白中和肝素对体外循环辅助下冠状动脉旁路移植术围术期的影响

摘要

目的 探讨不同剂量鱼精蛋白中和肝素对体外循环辅助下冠状动脉旁路移植术(CABG)围术期的影响.方法 选取2015年1月—2016年11月收治的180例体外循环下CABG患者,随机分为鱼精蛋白1～3组,每组60例.体外循环开始前给予3 mg/kg肝素,心内手术结束以后,鱼精蛋白1组用鱼精蛋白中和肝素后使活化凝血时间(ACT)高于插管前ACT的10％,鱼精蛋白2组中和至使ACT与插管前相当,鱼精蛋白3组中和至使ACT低于插管前10％.比较3组术中及术后相关指标的差异.结果 3组患者住院期间无死亡.相比1组和2组,鱼精蛋白3组的手术时间、出手术室前ACT、返回ICU 1 h后ACT、术中出血量、关胸时间和术中红细胞输注量减少,鱼精蛋白总量和鱼精蛋白与肝素比值升高(均P＜ 0.05).3组术后心功能不全、围术期心肌梗死、肺水肿、肺部感染、肾功能不全、伤口愈合不良、神经系统并发症、住院时间等指标比较差异无统计学意义(P＞0.05).结论 鱼精蛋白中和肝素使ACT达到术前ACT的90％较为安全,能明显减少出血量,缩短关胸时间及红细胞输注量,有一定的临床意义.%Objective To investigate the effect of different doses of protamine neutralizing heparin on perioperation of on-pump coronary artery bypass graftting (CABG).Methods A total of 180 on-pump CABG patients hospitalized from January 2015 to November 2016 were randomly divided into three groups,the protamine group l,protamine group 2 and protamine group 3,60 patients in each group.Heparin (3 mg/kg) was used before extracorporeal circulation.After intracardiac operation was over,protamine was used to neutralize the heparin to adjust the activated clotting time (ACT) in protamine group 1,which was 10％ higher than that of intubation.Meanwhile,protamine group 2 was neutralized to equal to the ACT before intubation,and protamine group 3 was 10％ lower than that before the intubation.The differences of intraoperative and postoperative parameters were compared between the three groups.Results No death was found in the three groups during hospitalization.Comparing with protamine group 1 and protamine group 2,the time of operation,the ACT before the leaving operation room,the ACT of the first hour after returning to ICU,the amount of bleeding during operation,the time of closing and the amount of red blood for transfusion were decreased in protamine group 3 (P ＞ 0.05).The total amount of protamine for neutralizing and the ratio of protamine and heparin were significantly increased in protamine group 3 (P ＜ 0.05).The heart dysfunction after operation,perioperative myocardial infarction,pulmonary edema,pulmonary infection,renal dysfunction,poor wound healing,neurological complications,and time of in hospital stay showed no significant differences between three groups (P＞0.05).Conclusion ACT below 10％ of preoperation is safe,after neutralization of heparin by protamine,which can obviously reduce the bleeding,the time of sternal closure and the amount of red blood cell transfusion,showing a positive clinical significance.