心内直视术中应用不同剂量鱼精蛋白拮抗肝素的临床对比分析

目的：通过临床对比研究心内直视术中不同剂量鱼精蛋白拮抗肝素，为低剂量鱼精蛋白使用的合理性提供依据。方法：比较1105例心内直视术中用传统剂量鱼精蛋白拮抗肝素患者（回顾性调查）和1000例用低剂量鱼精蛋白拮抗肝素患者（前瞻性研究）的鱼精蛋白毒副反应、术后出血和输血量、肝素反跳现象、追加鱼精蛋白情况和围体外循环期白陶土激活的的激活凝血时间（ACT）变化趋势。结果：传统剂量组的鱼精蛋白毒副反应发生率（4．8％）显著高于低剂量组（3．0％），P〈0．05；两组病人围体外循环期ACT变化趋势、追加鱼精蛋白情况、术后引流量、输血量和肝素反跳率无显著差别（P〉0．05）。结论：体外循环结束后降低拮抗肝素的鱼精蛋白剂量可显著减少鱼精蛋白毒副反应，不但能有效逆转肝素抗凝，且并不增加术后非外科性出血和输血量，是一种合理的鱼精蛋白拮抗肝素的方法。

Clinical Study of Different Dose Protamine Reversal of Heparin in Open Heart Surgery

Objective: To perform a clinical contrast study of different dose protamine reversal of heparin in open heart surgery, and provide basis for low-dose protamine reversal of heparin. Methods: The incidence of adverse reaction (ADR) to protamine, postoperative bleeding, transfusion requirements, heparin rebound, supplement protamine dose and ACT change were compared between received traditional dose protamine (group T, n=1105) and received low-dose protamine (group L,n=1000) in patients undergoing open heart operation under cardiopulmonary bypass (CPB). Results; The incidence of ADR to protamine was significantly higher in group T (4. 8%) (P<0. 05) than in group L (3.0%). The postoperative bleeding, transfusion requirements, heparin rebound, supplement protamine dose and ACT change had no significantly differences between groups (P>0.05). Conclusion:Low-dose protamine can significantly reduce the incidence of ADR It is not only very effective in reversal of heparin anticoagulation, but also not resulting in an increasing postoperative bleeding and transfusion, so it is a kind of rational protamine reversal of heparin.