体外循环心脏手术患者肝素敏感性与术后出血量的关系
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Heparin sensitivity and postoperative blood loss in patients undergoing cardiac surgery with cardiopulmonary bypass
背景与目的
肝素相关性凝血障碍是导致体外循环心脏手术患者术后出血的重要因素。目前，肝素敏感性与术后出血的关系尚不清楚。本研究旨在探讨心脏手术患者个体肝素敏感性与术后出血量的关系。
方 法
共纳入195名接受心脏瓣膜置换手术的成人患者。给予肝素初始剂量(2.5 mg·kg~(-1))后，根据全血活化凝血时间(ACT)分为3组：A组为不敏感组(ACT<480s)，B组为敏感组(480s<ACT<750s)，C组为超敏组(ACT>750s)。主要检测指标：一、术中及术后24h出血量。二、抗凝血酶(AT)和凝血因子X mRNA水平。三、血浆AT-Ⅲ、凝血因子X水平。四、肝素敏感指数。
结 果
B组出血量比A、C组减少约20%~25%，差异有统计学意义(P<0.01)。AT-ⅢmRNA水平从A组到C组逐渐升高，且与肝素敏感性呈正相关；因子X mRNA表达呈相反方向变化，A组与C组比较差异有统计学意义(P<0.05)，血浆凝血因子X水平与其mRNA的变化趋势一致。B组血浆AT-Ⅲ水平明显低于A、C组(P<0.05)。
结 论
心脏手术患者术后出血量与肝素敏感性有关，中度敏感患者术后出血最少。肝素敏感性的个体差异与AT-Ⅲ和因子X的mRNA和血浆水平有关。
原始文献摘要
Ma HP, Xu WF, Yu J,et,al.Heparin sensitivity and postoperative blood loss in patients undergoing cardiac surgery with cardiopulmonary bypass[J].Eur J Anaesthesiol. 2020 Mar;37(3):162-169. doi: 10.1097/EJA.0000000000001148.
BACKGROUND Heparin-associated coagulation disorder is an important factor related to postoperative bleeding in patients undergoing cardiac surgery with cardiopulmonary
bypass. Currently, the relationship between heparin sensitivity and postoperative bleeding is unknown.
OBJECTIVE To investigate the relationship between individual heparin sensitivity and postoperative blood loss in patients undergoing cardiac surgery.
DESIGN Prospective controlled study.
SETTING Tertiary teaching hospital, Urumqi, Xinjiang, PR China. The study was conducted from January 2016 to August 2018.
PATIENTS A total of 195 adult patients undergoing cardiac valve replacement surgery were included.
INTERVENTION After initial heparin dosing (2.5 mg. kg-1),patients were divided into three groups according to the whole blood activated clotting time (ACT): group A, insensitive group (ACT<480 s); group B, sensitive group(480 s<ACT<750 s); group C, hypersensitive group(ACT>750 s).
MAIN OUTCOME MEASURES First, intra-operative and 24-h postoperative blood loss. Second, antithrombin (AT) and factor X mRNA levels. Third, the plasma levels of AT-IIIand factor X. Fourth, heparin sensitivity index.
RESULTS Blood loss was approximately 20 to 25% lower in group B than in groups A and C, which was statistically significant (P<0.01). The AT-III mRNA levels increased from groups A to C and was positively associated with heparin sensitivity; the factor X mRNA levels changed in the opposite direction; a significant difference was observed between groups A and C (P<0.05). The factor X plasma level showed the same trend as its mRNA. The AT-III plasma level was significantly lower in group B than in groups A and C (P<0.05).
CONCLUSION Postoperative blood loss is related to heparin sensitivity in patients undergoing cardiac surgery, and the moderately sensitive patients have the least postoperative bleeding. Individual variation in heparin sensitivity is related to the mRNA and plasma levels of AT-III and factor X.
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贵州医科大学高鸿教授课题组
翻译：牛振瑛 编辑：冯玉蓉 审校：王贵龙