Heparin sensitivity and postoperative blood loss in patients undergoing cardiac surgery with cardiopulmonary bypass
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。
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.
翻译：牛振瑛 编辑：冯玉蓉 审校：王贵龙
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