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APTT监测体外循环后肝素中和与反跳 |
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李太富 邓硕曾
摘要 目的：评价激活部分凝血活酶时间(APTT)用于监测体外循环后肝素中和与反跳。方法：择期风心病瓣膜替换术病人20例，CPB后于不同时点测定激活部分凝血活酶时间(APTT)和激活全血凝固时间(ACT)。结果：鱼精蛋白/肝素为0.5∶1、0.7∶1和1∶1拮抗后APTT值依次缩短(P＜0.05)，ACT值无明显改变；0.5∶1和0.7∶1拮抗的血浆经体外鱼精蛋白滴定后，APTT均缩短(P＜0.05)，1∶1拮抗的血浆经体外滴定后，APTT没有变化。1∶1拮抗后3小时和6小时有2例APTT值明显延长(119秒，77.3秒)，经体外滴定后缩短(63.5秒，29.8秒)。结论：鱼精蛋白/肝素为1∶1基本上可完全中和肝素；与ACT相比较，APTT监测鱼精蛋白拮抗后肝素残留作用和肝素反跳现象可能更准确。
关键词 心肺转流术 激活部分凝血活酶时间 肝素
The role of the activated partial thromboplastin time （APTT） in heparin neutralization and rebound following cardiopulmonary bypass Li Taifu，Deng Shuozeng.Department of Anesthesiology，Cardiovascular Institute and Fuwai Hospital，CAMS and PUMC，Beijing 100037
Abstract Objective：To evaluate APTT for monitoring heparin neutralization and rebound following CPB. Method：Twenty patients undergoing cardiac valve replacement were randomly selected， APTT and activated clotting time （ACT） were measured 10 minutes following protamine in 0.5∶1，0.7∶1 and 1∶1 ratio to total heparin administered， and 3 and 6 hours after 1∶1 ratio．Result：After the neutralization of the heparin／protamine at ratio of 0.5∶1 ，the further doses of protamine （0.7∶1，1∶1)decreased APTT markedly (P＜0.05)， but ACT did not change (P＞0.05)．APTT with 0.5∶1 or 0.7∶1 ratio neutralization decreased significantly after in vitro protamine titration (P＜0.05)，and APTT with 1∶1 ratio remained unchanged after in vitro titration (P＞0.05)．Conclusion： APTT is a better assay for monitoring both inadequate reversal of heparin and heparin rebound，and is more sensitive to minimal dose heparin than ACT．The dose ratio of protamine to heparin at 1∶1 may reverse heparin effect completely．
Key words Cardiopulmonary bypass Heparin Activated partial thromboplastin time
激活部分凝血活酶时间(APTT)是内源性凝血系统的筛选指标，对小剂量肝素有较高的敏感性，是目前监测肝素治疗的最常用方法〔1〕。
资料与方法
择期风湿性心脏病瓣膜替换术病人20例，男13例，女7例，年龄42.3±8.5岁，体重60.5±9.4kg，心功能Ⅱ～Ⅲ级，术前无抗凝治疗，出凝血检查和肝肾功能正常。体外循环用Sarns机，膜式氧合器，用乳酸林格氏[1] [2] [3] 下一页
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