HEPARIN-PROTAMINE LUNG VASOCONSTRICTION AT HEART SURGERY

在前瞻性随机研究中，我们将阻断导致 当肝素抗凝作用被逆转时， 鱼精蛋白在最近对925例接受心脏手术的患者进行的前瞻性研究中， 在马萨诸塞州总医院的手术中，我们发现14例患者（1.5%） 发生急性一过性肺动脉高压， 增加血液血栓素水平（一种强有力的类花生酸肺 血管收缩剂）。 严重时，这种反应可能会导致休克， 支气管收缩和死亡。 我们之前的动物和临床研究 探索了这种不良药物相互作用的生化途径， 找到了阻止反应的关键点 在一项初步临床研究中， 将检查血栓素受体阻滞剂，以了解IE是否足以 在心脏手术中安全使用。 然后我们将测试竞争对手 血栓烷受体抑制剂能够阻断这种反应， 对1250例接受心脏手术的患者进行的前瞻性随机研究。

In prospective randomized study we will block the key mediator that leads to cardiopulmonary collapse when heparin anticoagulation is reversed by protamine. In recent prospective study of 925 patients undergoing cardiac surgery at Massachusetts General Hospital we found 14 patients (1.5%) developed acute transient pulmonary hypertension associated with markedly increased blood thromboxane levels (a powerful eicosanoid pulmonary vasoconstrictor). When severe, this reaction can cause shock, bronchoconstriction and death. Our prior animal and clinical studies have probed the biochemical pathways of this adverse drug interaction, and identified a key point to block the reaction. In a pilot clinical study we will examine a thromboxane receptor blocker to learn if ie is sufficiently safe for use at cardiac surgery. Then we will test the competitive thromboxane receptor inhibitor for is ability to block this reaction in a prospective randomized study of 1250 patients undergoing heart surgery.