n vitro and in vivo effects of hemodilution on kaolin-based activated clotting time predicted heparin requirement using a heparin dose-response technique.
n vitro and in vivo effects of hemodilution on kaolin-based activated clotting time predicted heparin requirement using a heparin dose-response technique.
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使用肝素剂量反应技术，血液稀释对基于高岭土的活化凝血时间的体外和体内影响预测了肝素需求。
DOI：
10.1007/s00540-016-2227-9
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Komori M.
中科院分区：
文献类型：
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作者：
Ichikawa J;Hagihira S;Mori T;Kodaka M;Nishiyama K;Ozaki M;Komori M.
目的肝素剂量反应（HDR）技术是基于对固定剂量肝素推注的活化凝血时间（ACT）反应，其在患者之间差异很大。目前还不清楚，但是，是否血液稀释相关的减少凝血和抗凝因素的影响HDR slope.MethodsFor在体外血液稀释，等份的全血从健康志愿者稀释9：1和8：2 v/v与生理盐水。对于体内血液稀释，对46例接受择期心血管手术（有或无心肺转流）的患者进行了一项前瞻性观察性研究。HDR斜率，抗凝血酶（AT）活性，全血细胞计数，和其他凝血参数进行了比较后，诱导麻醉和血液稀释后，500 ml的静脉内fluid.ResultsIn体外10和20%的血液稀释显着增加HDR斜率相对于基线，减少肝素的需求。肝素化样本的血液稀释显著延长ACT，而非肝素化血液无显著变化。纤维蛋白原和AT活性的百分比变化在20%时显著大于其他凝血变量。在体内，血液稀释显著增加了HDR斜率并降低了肝素需求。血液稀释引起的纤维蛋白原变化百分比显著大于AT活性变化。300和450 s的目标ACT没有达到83.3和53.8%的patients.ConclusionIn体外和体内血液稀释显着增加了HDR斜率，降低了肝素的需求。在体外，HDR斜率没有平行变化，而是变得更陡，这取决于血液稀释的程度。
PurposeThe heparin dose–response (HDR) technique is based on activated clotting time (ACT) response to a fixed-dose heparin bolus, which varies substantially among patients. It is unclear, however, whether hemodilution-associated reductions in coagulation and anticoagulation factors affect the HDR slope.MethodsFor in vitro hemodilution, aliquots of whole blood from healthy volunteers were diluted 9:1 and 8:2 v/v with normal saline. For in vivo hemodilution, a prospective observational study was performed on 46 patients who underwent elective cardiovascular surgery with or without cardiopulmonary bypass. HDR slope, antithrombin (AT) activity, complete blood count, and other coagulation parameters were compared after induction of anesthesia and after hemodilution with 500 ml of intravenous fluid.ResultsIn vitro 10 and 20 % hemodilution significantly increased the HDR slope relative to baseline, reducing the heparin requirement. Hemodilution of heparinized samples significantly prolonged ACT, whereas there was no significant change in non-heparinized blood. The percent changes in fibrinogen and AT activity were significantly greater at 20 % than those of the other coagulation variables. In vivo, hemodilution significantly increased the HDR slope and reduced heparin requirement. The percent change in fibrinogen due to hemodilution was significantly greater than the change in AT activity. Target ACTs of 300 and 450 s were not achieved in 83.3 and 53.8 % of patients, respectively.ConclusionIn vitro and in vivo hemodilution significantly increased the HDR slope and reduced the requirement for heparin. In vitro, the HDR slope did not change in parallel but became steeper, depending on the degree of hemodilution.