出血是心脏术后患者常见并发症之一。两种滴定法预测鱼精蛋白的用量均能够减少术后出血,但依赖于对血容量的正确估计。(1)根据滴定结果绘制肝素和鱼精蛋白剂量-反应曲线,从而计算鱼精蛋白需要量; (2)使用系列鱼精蛋白梯度杯绘制肝素-鱼精蛋白滴定结果曲线,从而直接读出鱼精蛋白的使用量。如心功能异常导致患者血容量变化,可在第一次滴定后进行第二次滴定实验,再根据这一实验结果补充鱼精蛋白。后者对于瓣膜疾病导致的患者血容量增高尤为适用。
Citation:
唐佳丽,秦臻,杜磊. 滴定法预测肝素-鱼精蛋白量减少体外循环术后出血. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(6): 723-724. doi: 10.7507/1007-4848.20130219
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Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
1. |
Woodman RC, Harker LA. Bleeding complications associated with cardiopulmonary bypass. Blood, 1990, 76 (9):1680-1697.
|
2. |
Skubas NJ, Gj D. Optimal management of bleeding complications after cardiac surgery. Semin Cardiothorac Vasc Anesth, 2001, 5 (3):217-228.
|
3. |
米勒. 米勒麻醉学. 北京:北京大学医学出版社, 1990-1992.
|
4. |
DeLaria GA, Tyner JJ, Hayes CL, et al. Heparin-protamine mismatch.A controllable factor in bleeding after open heart surgery. Arch Surg,1994, 129 (9):944-950.
|
5. |
Bull BS, Korpman RA, Huss WM, et al. Heparin therapy during extrac orporeal circulation. I. Problems inherent in existing heparin protocols. J Thorac Cardiovasc Surg,.
|
6. |
Ghai J, Luzt C, Ramamuthy N, et al. Method for testing a multi-channel blood assay cartridge . 2011[2013-07-17] . http://www.google. com. hk/patents .
|
7. |
Akl BF, Vargas GM, Neal J, et al. Clinical experience with theactivated clotting time for the control of heparin and protamine therapy during cardiopulmonary bypass. J Thorac Cardiovasc Surg, 1980, 79 (1):97-102.
|
8. |
Jobes DR, Aitken GL, Shaffer GW. Increased accuracy and precisionof heparin and protamine dosing reduces blood loss and transfusion in patients undergoing primary cardiac operations. J Thorac Cardiovasc Surg, 1995, 110 (1):36-45.
|
9. |
Preiss DU, Schmidt-Bleibtreu H, Berguson P, et al. Blood transfusionrequirements in coronary artery surgery with and without the activatedclotting time (ACT) technique. Klin Wochenschr, 1985, 63 (6):252-256.
|
10. |
Gruenwald CE, Manlhiot C, Chan AK, et al. Randomized, controlledtrial of individualized heparin and protamine management in infants undergoing cardiac surgery with cardiopulmonary bypass. J Am Coll Cardiol, 2010, 56 (22):1794-1802.
|
11. |
唐佳丽, 李刚, 杜磊, 等. 鱼精蛋白个体化使用减少心脏直视手术后患者出血的研究. 中国胸心血管外科临床杂志, 2010, 17 (2):105-108.
|
12. |
Guo Y, Tang J, Du L, et al. Protamine dosage based on two titrationsreduces blood loss after valve replacement surgery:a prospective, double-blinded, randomized study. Can J Cardiol, 2012, 28 (5):547-552.
|
13. |
, 69 (5):674-684.
|
- 1. Woodman RC, Harker LA. Bleeding complications associated with cardiopulmonary bypass. Blood, 1990, 76 (9):1680-1697.
- 2. Skubas NJ, Gj D. Optimal management of bleeding complications after cardiac surgery. Semin Cardiothorac Vasc Anesth, 2001, 5 (3):217-228.
- 3. 米勒. 米勒麻醉学. 北京:北京大学医学出版社, 1990-1992.
- 4. DeLaria GA, Tyner JJ, Hayes CL, et al. Heparin-protamine mismatch.A controllable factor in bleeding after open heart surgery. Arch Surg,1994, 129 (9):944-950.
- 5. Bull BS, Korpman RA, Huss WM, et al. Heparin therapy during extrac orporeal circulation. I. Problems inherent in existing heparin protocols. J Thorac Cardiovasc Surg,.
- 6. Ghai J, Luzt C, Ramamuthy N, et al. Method for testing a multi-channel blood assay cartridge . 2011[2013-07-17] . http://www.google. com. hk/patents .
- 7. Akl BF, Vargas GM, Neal J, et al. Clinical experience with theactivated clotting time for the control of heparin and protamine therapy during cardiopulmonary bypass. J Thorac Cardiovasc Surg, 1980, 79 (1):97-102.
- 8. Jobes DR, Aitken GL, Shaffer GW. Increased accuracy and precisionof heparin and protamine dosing reduces blood loss and transfusion in patients undergoing primary cardiac operations. J Thorac Cardiovasc Surg, 1995, 110 (1):36-45.
- 9. Preiss DU, Schmidt-Bleibtreu H, Berguson P, et al. Blood transfusionrequirements in coronary artery surgery with and without the activatedclotting time (ACT) technique. Klin Wochenschr, 1985, 63 (6):252-256.
- 10. Gruenwald CE, Manlhiot C, Chan AK, et al. Randomized, controlledtrial of individualized heparin and protamine management in infants undergoing cardiac surgery with cardiopulmonary bypass. J Am Coll Cardiol, 2010, 56 (22):1794-1802.
- 11. 唐佳丽, 李刚, 杜磊, 等. 鱼精蛋白个体化使用减少心脏直视手术后患者出血的研究. 中国胸心血管外科临床杂志, 2010, 17 (2):105-108.
- 12. Guo Y, Tang J, Du L, et al. Protamine dosage based on two titrationsreduces blood loss after valve replacement surgery:a prospective, double-blinded, randomized study. Can J Cardiol, 2012, 28 (5):547-552.
- 13. , 69 (5):674-684.