Impact of protamine dose on activated clotting time and thromboelastography in infants and small children undergoing cardiopulmonary bypass
Impact of protamine dose on activated clotting time and thromboelastography in infants and small children undergoing cardiopulmonary bypass
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DOI：
10.1111/pan.12109
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发表时间：
2013-03-01
影响因子：
1.7
通讯作者：
Norvell, Daniel C.
中科院分区：
文献类型：
--
作者：
Gautam, Nischal K.;Schmitz, Michael L.;Norvell, Daniel C.
目的 研究两种鱼精蛋白给药策略对活化凝血时间 (ACT) 和血栓弹力图 (TEG) 的影响。背景 基于患者和心肺旁路 (CPB) 泵的合并估计血容量 (EBV) 中存在的中和肝素的鱼精蛋白剂量可能会导致鱼精蛋白过量，并导致儿科患者可通过 ACT 和 TEG 检测到的凝血病。方法 本次回顾性前后设计研究纳入了 100 名 1 个月至 5 岁接受 CPB 的儿童患者。联合 EBV 组由 50 名连续患者组成，其鱼精蛋白剂量经计算以中和患者和泵的联合 EBV 中的肝素。 Pt-EBV 组由接下来的 50 名连续患者组成，其鱼精蛋白剂量经计算可中和患者 EBV 中的肝素。结果 各组之间的基线和鱼精蛋白后 ACT 相似。鱼精蛋白后肝素测定（Hepcon）显示两组均不存在残留肝素。鱼精蛋白后高岭土-肝素酶 TEG 显示，与 Pt-EBV 组相比，Combined-EBV 组的 R 延长了 7.5 分钟（平均 R 分别为 20.17 和 12.4 分钟，P
Objectives To study the effect of two protamine-dosing strategies on activated clotting time (ACT) and thromboelastography (TEG). Background Protamine dosage based on neutralizing heparin present in the combined estimated blood volumes (EBVs) of the patient and cardiopulmonary bypass (CPB) pump may result in excess protamine and contributes toward a coagulopathy that can be detected by ACT and TEG in pediatric patients. Methods A total of 100 pediatric patients 1month to 5years of age undergoing CPB were included in this retrospective before/after design study. Combined-EBV group consisted of 50 consecutive patients whose protamine dose was calculated to neutralize heparin in the combined EBVs of the patient and the pump. Pt-EBV group consisted of the next 50 consecutive patients whose protamine dose was calculated to neutralize heparin in the patient's EBV. Results Baseline and postprotamine ACTs were similar between groups. Postprotamine heparin assay (Hepcon) showed the absence of residual heparin in both groups. Postprotamine kaolin-heparinase TEG showed that R was prolonged by 7.5min in the Combined-EBV group compared with the Pt-EBV group (mean R of 20.17 vs 12.4min, respectively, P