Effect Of Blood Conservation Of Agkistrodon Acutus Hemocoagulase And Ulinasttainin Cardiac Valve Replacement With Cardiopulmonary

objective:To observe the effects of Agkistrodon acutus hemocoagulase on blood protection in cardiac valve replacement with cardiopulmonary and the influence on post mastectomy relief period and ley a clinical theoretical fundamental in combination of those two drugs.Methods:100 of cardiopulmonary bypass heart valve replacement surgery patients were randomly divided into Control group(Group A), Agkistrodon acutus hemocoagulase group(Group B), Ulinasttain group(Group C), and Combined treatment group(Group D). With 25 patients each group, Group A was given the same amount of saline; Group B was given 1U Agkistrodon acutus hemocoagulase join priming into the body; Group C was given Ulinastatin 10,000 U/kg added to the priming solution into the body and D Group was given 1U Agkistrodon acutus hemocoagulase and Ulinastatin 10,000 U/kg added to the priming solution into the body. To analyze Agkistrodon acutus hemocoagulase and Ulinastatin protective effects,coagulation parameters, including: platelet(PLT) count, prothrombin time(PT), activated partial thromboplastic time(APTT), thrombin time(TT), fibrinogen(FIB) and D-dimer(D-D) were collected under before the monitoring the incision(T1), 30 min after CPB start(T2), and 20 min after the heparin was neutralized by protamine(T3) and 24 h after the surgery(T4), four time points. Besides, record the clinical parameters perioperative, includingintraoperative cardiac resuscitation situations, cardiopulmonary bypass time, aortic cross-clamping time, drainage, blood transfusion and other related indicators.Results:There are no significant differences in general preoperative situation of the selected 100 patients. A, B, C, D four groups preoperative comparison results of PLT count, PT, APTT, TT, FIB and D-D were not statistically significant(P>0.05). Changes of four groups PLT count at different time points: T2 when compared with T1, levels were significantly decreased(P <0.01),wherein, B, C and D three groups were significantly higher than the level in Group A(P<0.001); at T3, PLT count level of four groups have varying degrees of recovery compared with T2, however, B, C and D three groups count levels remained significantly higher than Group A(P<0.001); 24 h after the surgery, four groups PLT count level have no significant difference with each other(P>0.05), but lower than the preoperative level(P<0.01). Four groups PT, APTT and TT changes at different time points: at T3,four groups PT are significantly increased compared with T1(P <0.01), which B, C and D three groups have lower PT compared with Group A(P<0.01); at T4, four groups returned to preoperative levels, no significant difference between groups(P>0.05). At T3, four groups APPT significantly increased(P<0.01), while B, C and D three groups are significantly reduced than in Group A, which Group Bhas less difference with the control group as Group B and C do(P<0.01 and P<0.001); at T4, four groups of PT returned to preoperative levels(P>0.05). TT, with different results as previous, patients in, B, C and D groups compared significantly shorter(P<0.001) than T1 at T3, while the control group comparedwith the preoperative, significantly prolonged(P<0.001).Therefore,at T3, B, C and D groupsare significantly shorter(P <0.001) in TT than in Group A. Such a huge difference hasreturned to preoperative levels 24 h after the surgery, and there was no significant difference between groups(P> 0.05). Four groups at different time points of FIB and D-D changes: at T3, the four groups FIB content show slightly decrease, but no significant difference(P> 0.05)compared with T1. There’s no significant difference between the groups, either(P> 0.05). For D-D content, the four groups are significantly increased(P<0.01) at T2, but B, C and D three groups are significantly reduced than Group A, which Group C has the most significantly decrease(P<0.01).At T3, all four groups are still significantly higher than the preoperative level, but B, C and D are significantly decreased(P<0.05)compared with Group A.This significant differencedisappeared at T4(P> 0.05). In addition, there is a significant decrease in postoperative drainage of B, C and D groups(P<0.01) than in Group A, and the combined treatment group is even less than the other two(P <0.001). Compared with the control group, B, C and D groups can significantly reduce perioperative blood transfusion(P <0.01); and the combination group show a more significantly decreased than the other two(P <0.001). Patients perioperative general circumstance of those four groups, including: heart jump stop time, CPB time and aortic cross-clamping time are not statistically different(P> 0.05).Conclusion:Agkistrodon acutus hemocoagulase and Ulinasttain can play a protective effect of blood in cardiopulmonary bypass heart valve replacement surgery through significant anti-fibrinolytic functionand platelet protection, and combination therapy reach a relatively better protective effect.