体外循环心脏直视术中鱼精蛋白毒性反应的临床防治

目的：探讨体外循环心脏直视术中鱼精蛋白毒性反应的临床特点及防治对策，方法：回顾性分析连续1727体外循环心脏直视术病例，参照Oe及Weiler标准将其分为有反应组（鱼精蛋白毒性反应组）和无反应组，并将有反应组分为轻度和中重度反应组，分析其临床特点，结果：发生鱼精蛋白毒性反应者43例，发生率2．48％，其中轻度反应者35例（81．39％，35／43），中重度反应者8例（18．61％，8／43），有反应组与反应组临床一般情况无明显差别，中重度反应组转流时间及反应持续时间明显较轻度反应组长（P＜0．05）。中重度反应组死亡2例。结论：体外循环心脏直视术中鱼精蛋白毒性反应的发生难以预料；中重度反应者后果严重；临床上应充分认识鱼精蛋白毒性反应的特点，对转流时间较长的患者的应高度警惕鱼精蛋白毒性反应的发生；低浓度缓慢静脉给药可减少毒性反应的发生，发生严重毒性反应者应立即停药，迅速肝素化并再转机辅助循环，有利于对中重度毒性反应的救治。

A clinical management of adverse reaction to protamine sulfate during open heart operation under cardiopulmonary bypass

Objective To review the clinical characteristics and management of adverse reaction (ADR) to protamine sulfate during open heart operation under cardiopulmonary bypass (CPB). Method Continuous 1 727 patients who underwent open heart operation under CPB were retrospectively reviewed. The clinical characteristics were compared between reaction group (mild reaction group and moderate-severe reaction group) and non-reaction group by referring to Oe's and Weiler's standards. Results 43 patients (2.48%) had ADR to protamine. The clinical data and CPB parameters had no significantly differences between reaction group and non-reaction group, but the bypass time and continuous reaction time were significiently longer in moderate-severe group than that in mild reaction group( P <0.05).Conclusion The ADR to protamine could not be predicted during open heart operation under CPB, and the outcome was critical in moderate-severe group. Recognizing the clinical characteristics was very important. Long-time bypass patient should be on guard against the ADR to protamine. Low concentration and slowing venous administration could reduce the occurrence of ADR to protamine. Immediate reheparinization and re-bypass were effective for rescue when severe ADR happened.