国际麻醉学与复苏杂志   2010, Issue (1): 30-33
    
CABG 术中 ACT、 CR 监测方法的比较
甄宇 郑莉 丁冠男 洪方晓 槐庆元 田鸣1()
1.首都医科大学附属北京友谊医院麻醉科
The comparation of the methods of monitoring ACT and CR during CABG
 全文:
摘要:

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 ACT test,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(T0)、首次给肝素(OP 组0.8 mg/kg,CPB组1.0 mg/kg)后5 min(T1),追加肝素(OP组达 1.5 mg/kg,CPB组达3.0 mg/kg)后 5 min(T2),鱼精蛋白中和肝素后5 min(T3)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 ① T0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+0.09×(R=0.773,P<0.001);y=1.50+0.06×(R=0.882,P<0.001)。② T3点与T0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0.8 mg/kg 和1.0 mg/kg时,分别有39%和 83%患者C- ACT 大于300 s,而sonACT大于300 s的例数达55%和95%,kACT则是55%和100%;CR 的下降值(ΔCR)占基础值的百分比已达74%~76%和76%~83%。结论 ① SCA 3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,SCA 3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。

关键词: sonoclot;激活凝血时间;凝集速率;冠状动脉旁路移植术;凝血
Abstract:

Objective Activated clotting time(ACT) and fibrinogen(Fbg)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(T0),5 minutes after presenting heparin(0.8 mg/kg in OP group, 1.0 mg/kg in CPB group)(T1), 5 minutes after adding heparin(added to 1.5 mg/kg in OP group, 3.0 mg/kg in CPB group)(T2), 5 minutes after heparin neutralization with protamine(T3). Results ① At point T0, 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 between T0 and T3 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 ① The 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.

Key words: sonoclot; ACT; CR; CABG; coagulation