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血小板造血和两个激活凝血测试在心脏手术患者中检测蛋白质胺后残留的肝素:一项前性队列研究
Janne Moilanen1, Marika Pada, Pasi Ohtonen
1From the Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu (JM, MP, PO, TK, PT, TE), Department of Anesthesiology, Vaasa Central Hospital, Wellbeing Services County of Ostrobothnia, Vaasa (MP), Translational Medicine Research Unit, University of Oulu (PO) and Nordlab Oulu Hematology Laboratory, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland (E-RS).
临床检测,包括激活凝血时间 (ACT) 和血栓凝血计,显示在心脏手术后检测残留肝素的能力不佳. 这些测试是不可靠的,以确认完全逆转肝素与protamine.
科学领域:
- 心血管外科心血管外科
- 麻醉学 麻醉学
- 血液学 血液学 血液学
背景情况:
- 通过质氨酸完全逆转肝素是心脏手术后的关键.
- 需要对残留的肝素进行精确的临床监测.
研究的目的:
- 为了比较两个激活凝血时间 (ACT) 测试和血栓凝结度测试在检测前原胺后肝素活性方面的有效性.
- 评估这些点护理设备的诊断准确性.
主要方法:
- 一项前性观察性研究,涉及55名成人心脏手术患者.
- 对ACT-LR和ACT+测试 (Hemochron Signature Elite) 和INTEM:HEPTEM CT比率 (ROTEM Sigma) 进行分析,这些测试是在前胺剂后进行的.
- 根据抗Xa因子活性,患者被分为氨酸和无氨酸组.
主要成果:
- 在ACT-LR和ACT+测量之间观察到显著偏差.
- 两组之间ACT或CT比率变化没有显著差异.
- 接收器操作员特征曲线表明检测残留肝素的能力较差 (anti-fXa ≥0.2 IU/mL).
结论:
- 血红素签名精英ACT测试和ROTEM西格玛INTEM:HEPTEMCT比率都显示出有限的能力,以检测残留的氨酸后protamine.
- 目前的临床试验不足以可靠地评估心脏手术后的肝素逆转.
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