国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2010年
1期
30-33,55
,共5页
sonoclot%激活凝血时间%凝集速率%冠状动脉旁路移植术%凝血
sonoclot%激活凝血時間%凝集速率%冠狀動脈徬路移植術%凝血
sonoclot%격활응혈시간%응집속솔%관상동맥방로이식술%응혈
sonoclot%ACT%CR%CABG%coagulation
目的 冠状动脉旁路移植术(coronary artery bnypass graft,CABG)围术期常规监测激活凝血时间(activated clotting time,ACT)和纤维蛋白原(Fibrinogen,Fbg).通过使用Sonoclot凝血功能分析仪(sonoclot coagulation analyzer,SCA)与传统凝血检测的ACT(conventional ACTtest,C-ACT)和Fbg进行相关性分析,对CABG术中ACT、CR监测方法进行比较.方法 选择非体外循环(Off-pump)CABG患者18例(OP组),体外循环(cardiopulmonary bypass,CPB)CABG患者12例(CPB组),分别于诱导后(T_o)、首次给肝素(OP组0.8ms/ks,CPB组1.0mg/kg)后5min(T_1),追加肝素(OP组达1.5mg/kg,CPB组达3.0mg/kg)后5min(T_2),鱼精蛋白中和肝素后5 min(T_3)4个时间点,取中心静脉血同时测定C-ACT和SCA的3种ACT及CR.结果 ①T_o点,SonACT、kACT、aiACT分别与C-ACT正相关,相关方程分别为:y=83.15+0.37×(R=0.438,P<0.05);y=71.33+0.43×(R=0.509,P<0.01);y=56.19+0.78×(R=0.790,P<0.01).sonCR、kCR、aiCR与术前Fbg正相关,相关方程分别为:y=1.16+0.09×(R=0.821,P<0.001);y=1.11+0.09x(R=0.773,P<0.001);y=1.50+0.06×(R=0.882,P<0.001 .②T_3点与T_o点相比,C-ACT差异有统计学意义(P<0.01).sonACT、kACT、aiACT差异均无统计学意义.③给予低剂量肝素0.8mg/kg和1.0mg/kg时,分别有39%和83%患者C-ACT大于300 s,而sonACT大于300s的例数达55%和95%,kACT则是55%和100%;CR的下降值(ACR)占基础值的百分比已达74%-76%和76%-83%.结论 ①SCA3种ACT与C-ACT正相关性比较:aiACT>kACT>sonACT,aiACT相关性最好;CR与Fbg正相关性比较:aiCR>sonCR>kCR,aiCR相关性最好.②鱼精蛋白中和肝素后,SCA3种ACT比C-ACT恢复更好.③使用SCA与传统检测相比能够在低剂量肝素(0.8 mg/kg～1.0 mg/kg)时更敏感地监测ACT和CR.
目的 冠狀動脈徬路移植術(coronary artery bnypass graft,CABG)圍術期常規鑑測激活凝血時間(activated clotting time,ACT)和纖維蛋白原(Fibrinogen,Fbg).通過使用Sonoclot凝血功能分析儀(sonoclot coagulation analyzer,SCA)與傳統凝血檢測的ACT(conventional ACTtest,C-ACT)和Fbg進行相關性分析,對CABG術中ACT、CR鑑測方法進行比較.方法 選擇非體外循環(Off-pump)CABG患者18例(OP組),體外循環(cardiopulmonary bypass,CPB)CABG患者12例(CPB組),分彆于誘導後(T_o)、首次給肝素(OP組0.8ms/ks,CPB組1.0mg/kg)後5min(T_1),追加肝素(OP組達1.5mg/kg,CPB組達3.0mg/kg)後5min(T_2),魚精蛋白中和肝素後5 min(T_3)4箇時間點,取中心靜脈血同時測定C-ACT和SCA的3種ACT及CR.結果 ①T_o點,SonACT、kACT、aiACT分彆與C-ACT正相關,相關方程分彆為:y=83.15+0.37×(R=0.438,P<0.05);y=71.33+0.43×(R=0.509,P<0.01);y=56.19+0.78×(R=0.790,P<0.01).sonCR、kCR、aiCR與術前Fbg正相關,相關方程分彆為:y=1.16+0.09×(R=0.821,P<0.001);y=1.11+0.09x(R=0.773,P<0.001);y=1.50+0.06×(R=0.882,P<0.001 .②T_3點與T_o點相比,C-ACT差異有統計學意義(P<0.01).sonACT、kACT、aiACT差異均無統計學意義.③給予低劑量肝素0.8mg/kg和1.0mg/kg時,分彆有39%和83%患者C-ACT大于300 s,而sonACT大于300s的例數達55%和95%,kACT則是55%和100%;CR的下降值(ACR)佔基礎值的百分比已達74%-76%和76%-83%.結論 ①SCA3種ACT與C-ACT正相關性比較:aiACT>kACT>sonACT,aiACT相關性最好;CR與Fbg正相關性比較:aiCR>sonCR>kCR,aiCR相關性最好.②魚精蛋白中和肝素後,SCA3種ACT比C-ACT恢複更好.③使用SCA與傳統檢測相比能夠在低劑量肝素(0.8 mg/kg～1.0 mg/kg)時更敏感地鑑測ACT和CR.
목적 관상동맥방로이식술(coronary artery bnypass graft,CABG)위술기상규감측격활응혈시간(activated clotting time,ACT)화섬유단백원(Fibrinogen,Fbg).통과사용Sonoclot응혈공능분석의(sonoclot coagulation analyzer,SCA)여전통응혈검측적ACT(conventional ACTtest,C-ACT)화Fbg진행상관성분석,대CABG술중ACT、CR감측방법진행비교.방법 선택비체외순배(Off-pump)CABG환자18례(OP조),체외순배(cardiopulmonary bypass,CPB)CABG환자12례(CPB조),분별우유도후(T_o)、수차급간소(OP조0.8ms/ks,CPB조1.0mg/kg)후5min(T_1),추가간소(OP조체1.5mg/kg,CPB조체3.0mg/kg)후5min(T_2),어정단백중화간소후5 min(T_3)4개시간점,취중심정맥혈동시측정C-ACT화SCA적3충ACT급CR.결과 ①T_o점,SonACT、kACT、aiACT분별여C-ACT정상관,상관방정분별위:y=83.15+0.37×(R=0.438,P<0.05);y=71.33+0.43×(R=0.509,P<0.01);y=56.19+0.78×(R=0.790,P<0.01).sonCR、kCR、aiCR여술전Fbg정상관,상관방정분별위:y=1.16+0.09×(R=0.821,P<0.001);y=1.11+0.09x(R=0.773,P<0.001);y=1.50+0.06×(R=0.882,P<0.001 .②T_3점여T_o점상비,C-ACT차이유통계학의의(P<0.01).sonACT、kACT、aiACT차이균무통계학의의.③급여저제량간소0.8mg/kg화1.0mg/kg시,분별유39%화83%환자C-ACT대우300 s,이sonACT대우300s적례수체55%화95%,kACT칙시55%화100%;CR적하강치(ACR)점기출치적백분비이체74%-76%화76%-83%.결론 ①SCA3충ACT여C-ACT정상관성비교:aiACT>kACT>sonACT,aiACT상관성최호;CR여Fbg정상관성비교:aiCR>sonCR>kCR,aiCR상관성최호.②어정단백중화간소후,SCA3충ACT비C-ACT회복경호.③사용SCA여전통검측상비능구재저제량간소(0.8 mg/kg～1.0 mg/kg)시경민감지감측ACT화CR.
Objective Activated clotting time (ACT)and fibrinogen (Flog) are regularly monitored during Coronary Artery Bypass Graft(CABG). We got the results of ACT and CR by using Sonoclot coagulation analyzer(SCA) to canpare with conventional ACT test (C-ACT)and Fbg, and discussed the differences among the various methods of monitoring ACT and CR duning CABG.Methods 30 patients undergoing CABG were divided into 2 groups, off-pump CABG group(OP, n=18)and cardio-pulmonary bypass CABG group (CPB, n=12). Blood samples were collected through C-line to dertermine the value of C-ACT and sonACT, kACT,aiACT, sonCR, kCR and aiCR after induction (T_o), 5 minutes after presenting heparin (0.8 mg/kg in OP group, 1.0 mg/kg in CPB group)(T_1), 5 minutes after adding heparin (added to 1.5 mg/kg in OP group, 3.0 mg/kg in CPB group)(T_2), 5 minutes after heparin neutralization with protamine(T_3). Results ① At point To, the baseline of the three ACT of SCA all correlates with C mg/kgACT, the correlating equations are y =83.15 +0.37× (R=0.438, P<0.05), y =71.33 +0.43 × (R =0.509, P<0.01), y =56.19 +0.78× (R =0.790, P<0.01), respectively. And the CRs all correlates with Fbg, the correlating equations are y=1.16+0.09×(R=0.821, P<0.001);y=1.11+0.09×(R=0.773, P<0.001);y=1.50+0.06×(R=0.882, P<0.001), respectively. ② There is significant difference hetween T_o and T_3 on the results of C-ACT, P<0.01, but not the SCA results. ③ When the dose of heparin is low of 0.8mg/kg or1.0mg/kg, the percent of the patients whose C-ACT higher than 300 seconds is 39% or 83%, and whose sonACT and kACT higher than 300 seconds is 55% or more than 92%. The percent of the decrement of CR is 74%-76% or 76%-83%. Conclusion ①The comparation of the correlation:aiACT>kACT>SonACT, aiCR>sonCR>kCR, So both of aiACT and aiCR are more accruate than the others. ② After heparin neutralization, the recovery of the SCA results are better than C-ACT. ③ SCA is more sensitive than C-ACT when the dose of heparin is low such as 0.8 mg/kg-1.0 mg/kg.
