心内直视术中鱼精蛋白毒副反应的危险因素分析

目的　探讨心内直视手术中鱼精蛋白毒副反应发生的危险因素 ,找出预防措施。　方法　回顾性分析连续行心内直视手术的 2 10 5例患者输入鱼精蛋白的情况 ,按术中是否发生鱼精蛋白毒副反应将其分为有毒副反应组(n=83)和无毒副反应组 (n=2 0 2 2 )。比较两组间和有毒副反应组轻度与中重度反应患者间的临床特点。用 L ogistic回归方法分析术中发生鱼精蛋白毒副反应的高危因素。　结果　有毒副反应组平均鱼精蛋白用量显著高于无毒副反应组 (P<0 .0 5 )。有毒副反应组中重度反应患者毒副反应持续时间、体外循环 (CPB)时间和主动脉阻断时间均较轻度反应患者长 (P<0 .0 5 ) ;鱼精蛋白采用传统剂量患者毒副反应发生率 (4 .8% )较低剂量患者高 (3.0 % ,P<0 .0 5 )。多因素分析结果 ,鱼精蛋白剂量偏大是唯一的独立危险因素 (P=0 .0 0 3)。　结论　心内直视手术中鱼精蛋白毒副反应的发生难以预测 ,将鱼精蛋白剂量控制在最佳范围是预防毒副反应发生的重要措施之一。

Risk factors of adverse reaction to protamine in open heart operation

Objective To investigate the risk factors of adverse reaction to protamine in open heart operation, and seek preventive measures. Methods The clinical data of adverse reaction to protamine were retrospectively analyzed in 2 105 patients who consecutively underwent open heart operations under cardiopulmonary bypass (CPB). All patients were divided into adverse reaction group (n=83) and non-adverse reaction group (n= 2 022) according to the standard of adverse reaction to protamine. The clinical characteristics were compared between two groups. The risk factors of adverse reaction to protamine in open heart operation were analyzed with Logistic regression method. Results The average dosages of protamine were significantly higher in adverse reaction group than those in non-adverse reaction group (P<0.05). The adverse reaction to protamine lasting time, CPB times and aortic cross clamp time were significantly longer in patients with moderate-severe adverse reaction than those with mild reaction in adverse reaction group (P<0.05). The incidence of adverse reaction to protamine was significantly higher in patients received traditional dose protamine (4.8%) than those in low dose (3.0%, P<0.05). The greater dose of protamine was independent risk factor of adverse reaction to protamine by Logistic regression method (P=0.003). Conclusion The protamine adverse reaction can not be predicted. Controlling the most proper dose of protamine is one of the important step in prevention for adverse reaction to protamine.