心血管外科杂志(电子版)
心血管外科雜誌(電子版)
심혈관외과잡지(전자판)
Journal of Cardiovascular Surgery(Electronic Edition)
2015年
1期
20-23
,共4页
新疆维吾尔族%肝素耐药%先天性心脏病%抗凝血酶Ⅲ抗原%激活全血凝固时间
新疆維吾爾族%肝素耐藥%先天性心髒病%抗凝血酶Ⅲ抗原%激活全血凝固時間
신강유오이족%간소내약%선천성심장병%항응혈매Ⅲ항원%격활전혈응고시간
Xinjiang Uygur%Heparin resistance%Congenital heart disease%AntithrombinⅢantigen%Activation of whole blood clotting time
目的:探讨新疆维吾尔族、新疆汉族和郑州汉族先天性心脏病患者心肺转流肝素化剂量的差异。方法于2011年3月至2014年3月从郑州大学第五附属医院收治的郑州汉族先天性心脏病行心内直视矫治术患者100例,从武汉亚洲心脏病医院新疆医院收治的新疆维吾尔族先天性心脏病行心内直视矫治术患者200例,新疆汉族心内直视矫治术患者100例作为研究对象,根据民族差异和地区分为:新疆维吾尔族( A组)200例,新疆汉族( B组)、郑州汉族( C组)各100例。 A组依据首次肝素剂量不同分为两组,分别为A1组,给予肝素400 IU/kg(n=100),A2组,给予肝素500 IU/kg(n=100)。 B组、C组均给予400 IU/kg肝素。四组术前均采集抗凝静脉血测定抗凝血酶Ⅲ( AT唱Ⅲ)抗原含量。首次静脉注射肝素5 min后,测定并记录激活全血凝固时间( ACT)。 ACT值<480 s视为肝素耐药。400 s<ACT<480 s时追加首次肝素剂量的一半;ACT<400 s时追加首剂全量,复查ACT>480 s方可转机。追加剂量仍然耐药( ACT<480 s)时输入新鲜冰冻血浆。记录肝素耐药比例、肝素化达标剂量( IU/kg )。结果术前AT唱Ⅲ抗原含量测定, A1、A2组显著低于B、C两组(P<0畅05)。首次注射肝素后,A1组17例(17畅0%)ACT<480 s,其中11例(11畅0%)ACT<400 s,肝素耐药比例明显高于其他三组,肝素化达标剂量明显高于B、C两组( P<0畅05)。 A2、B、C组肝素耐药比例差异无统计学意义,但A2组肝素化达标剂量明显高于其他三组( P<0畅05)。结论新疆维吾尔族先天性心脏病患者发生肝素耐药性高于新疆汉族和郑州汉族患者,建议首次注射肝素化治疗时可调高剂量。
目的:探討新疆維吾爾族、新疆漢族和鄭州漢族先天性心髒病患者心肺轉流肝素化劑量的差異。方法于2011年3月至2014年3月從鄭州大學第五附屬醫院收治的鄭州漢族先天性心髒病行心內直視矯治術患者100例,從武漢亞洲心髒病醫院新疆醫院收治的新疆維吾爾族先天性心髒病行心內直視矯治術患者200例,新疆漢族心內直視矯治術患者100例作為研究對象,根據民族差異和地區分為:新疆維吾爾族( A組)200例,新疆漢族( B組)、鄭州漢族( C組)各100例。 A組依據首次肝素劑量不同分為兩組,分彆為A1組,給予肝素400 IU/kg(n=100),A2組,給予肝素500 IU/kg(n=100)。 B組、C組均給予400 IU/kg肝素。四組術前均採集抗凝靜脈血測定抗凝血酶Ⅲ( AT唱Ⅲ)抗原含量。首次靜脈註射肝素5 min後,測定併記錄激活全血凝固時間( ACT)。 ACT值<480 s視為肝素耐藥。400 s<ACT<480 s時追加首次肝素劑量的一半;ACT<400 s時追加首劑全量,複查ACT>480 s方可轉機。追加劑量仍然耐藥( ACT<480 s)時輸入新鮮冰凍血漿。記錄肝素耐藥比例、肝素化達標劑量( IU/kg )。結果術前AT唱Ⅲ抗原含量測定, A1、A2組顯著低于B、C兩組(P<0暢05)。首次註射肝素後,A1組17例(17暢0%)ACT<480 s,其中11例(11暢0%)ACT<400 s,肝素耐藥比例明顯高于其他三組,肝素化達標劑量明顯高于B、C兩組( P<0暢05)。 A2、B、C組肝素耐藥比例差異無統計學意義,但A2組肝素化達標劑量明顯高于其他三組( P<0暢05)。結論新疆維吾爾族先天性心髒病患者髮生肝素耐藥性高于新疆漢族和鄭州漢族患者,建議首次註射肝素化治療時可調高劑量。
목적:탐토신강유오이족、신강한족화정주한족선천성심장병환자심폐전류간소화제량적차이。방법우2011년3월지2014년3월종정주대학제오부속의원수치적정주한족선천성심장병행심내직시교치술환자100례,종무한아주심장병의원신강의원수치적신강유오이족선천성심장병행심내직시교치술환자200례,신강한족심내직시교치술환자100례작위연구대상,근거민족차이화지구분위:신강유오이족( A조)200례,신강한족( B조)、정주한족( C조)각100례。 A조의거수차간소제량불동분위량조,분별위A1조,급여간소400 IU/kg(n=100),A2조,급여간소500 IU/kg(n=100)。 B조、C조균급여400 IU/kg간소。사조술전균채집항응정맥혈측정항응혈매Ⅲ( AT창Ⅲ)항원함량。수차정맥주사간소5 min후,측정병기록격활전혈응고시간( ACT)。 ACT치<480 s시위간소내약。400 s<ACT<480 s시추가수차간소제량적일반;ACT<400 s시추가수제전량,복사ACT>480 s방가전궤。추가제량잉연내약( ACT<480 s)시수입신선빙동혈장。기록간소내약비례、간소화체표제량( IU/kg )。결과술전AT창Ⅲ항원함량측정, A1、A2조현저저우B、C량조(P<0창05)。수차주사간소후,A1조17례(17창0%)ACT<480 s,기중11례(11창0%)ACT<400 s,간소내약비례명현고우기타삼조,간소화체표제량명현고우B、C량조( P<0창05)。 A2、B、C조간소내약비례차이무통계학의의,단A2조간소화체표제량명현고우기타삼조( P<0창05)。결론신강유오이족선천성심장병환자발생간소내약성고우신강한족화정주한족환자,건의수차주사간소화치료시가조고제량。
Objective To explore the first dosage of heparin of cardiopulmonary bypass in Xinjiang Uygur , Han and Zhengzhou Han patients with congenital heart disease .Methods From March 2011 to March 2014 ,100 Han patients with congenital heart disease underwent heart surgery from Fifth Affiliated Hospital of Zhengzhou University,200 Xinjiang Uighur patients with congenital heart disease underwent heart surgery from the hospital in Wuhan Asia Heart Hospital , 100 Han patients in Xinjiang underwent heart surgery as research subjects were enrolled in this study .According to ethnic and regional differences the patients were divided into Xinjiang Uygur group (group A,200 cases),Xinjiang Han group (group B,100 cases),and Zhengzhou Han group (group C,100 cases).On the basis of the first dosage of heparin ,group A was divided into two different dosage of heparin (100 cases):group A1 (400 IU/kg),and group A2 (500 IU/kg),respectively.The dosage of heparin was 400 IU/kg both in group B and C .Venous blood was exsanguinated to assay anticoagulant antithrombin Ⅲ ( AT-Ⅲ) antigen before the operation .Activate blood clotting time ( ACT ) was measured and recorded in 5 min after intravenous heparin in the first time.It was regarded as heparin resistance when the ACT value was less than 480 s.When the ACT value was between 400 s and 480 s,half-dosage heparin of first time should be appended ,while when the ACT value was less than 400 s,full-dosage heparin should be appended .Make sure the ACT value was more than 480 s before initiating cardiopulmonary bypass .Fresh frozen plasma should be infused when it was still resistance after the additional dosage .Heparin resistance ratio and standard heparin dosage ( IU/kg ) were recorded .Results The level of AT-Ⅲantigens before the operation in group A 1 and A2 was significantly lower than group B and C ( P<0.05).After the first injection of heparin,there were 17 patients in group A1 whose ACT value was less than 480 s, of which 11 cases'ACT value was less than 400 s.The rate of heparin resistance was significantly higher than the other three groups ,the standard dosage of heparin was significantly higher than group B and C ( P<0 .05 ) , there were no statistically difference among Group A 2,B and C,but standard dosage heparin in group A 2 was significantly higher than the other three groups (P<0.05).Conclusion The occurrence of heparin resistance in patients with congenital heart disease in Xinjiang Uygur is higher than that in Xinjiang Han and Zhengzhou Han , in clinical treatment,we propose to increase the dosage heparin therapy for the first time .