| Objective: Postoperative bleeding is one of the major complications after cardiac surgery with cardiopulmonary bypass(CPB).Severe bleeding occurs in up to 10% of patients undergoing cardiac surgery,and increased bleeding is associated with a progressive increase in morbidity and mortality.Cardiac surgery is one of the populations with the highest utilization of blood products,with 20% to 40% of patients requiring transfusions for routine procedures.In cardiac surgery,inaccurate anticoagulation management may result in residual heparin or excessive protamine,both of which have the potential to cause postcardiopulmonary bypass bleeding and lead to increased postoperative blood transfusions.To date,there are no evidence-based practice guidelines to define the optimal management of anticoagulation during CPB.Studies justify the administration of heparin according to body weight to achieve adequate anticoagulation,but individual responses to heparin vary,and the optimal dose of protamine antagonist heparin in cardiac surgery remains unclear due to individual differences in heparin.Protamine is usually administered at a fixed protamine to heparin ratio that adjusts the dose based on the initial heparin dose and is independent of the heparin concentration remaining in the circulation at the end of CPB.Current studies suggest that individualized medication can antagonize the anticoagulant effect of heparin more precisely.However,it is affected by medical conditions,price and other factors,and the implementation plan is too complex to be popularized.The aim of this study was to determine the dose of protamine antagonist based on the in vivo heparin dose calculated from the heparin response curve,and then to use TEG to evaluate:(1)whether protamine dose management based on the heparin response curve can improve the outcomes related to cardiac valve surgery;(2)To explore the profile of TEG coagulation in patients with individualized protamine dose management after cardiac valve surgery with CPB.Methods:Seventy-two patients who underwent the first elective heart valve surgery in our hospital from March 2021 to October 2022 were selected.According to the inclusion and exclusion criteria,68 cases were finally obtained without secondary transfer.The patients were divided into control group(n = 32)and regimen group(n = 36)according to the ratio of initial heparin dose to protamine dose(1:1).Basal ACT and TEG parameters were measured before skin incision,ACT was recorded 5min after the initial heparin dose(heparinized ACT),and ACT was measured 5min after protamine neutralization(postneutralization ACT),TEG1,and heparinase TEG(TEG2).At the same time,the patients’ general information,24 hours thoracic drainage volume,blood transfusion volume and other observation indicators were recorded,and the differences of each index between the two groups were compared.SPSS25.0 software was used to analyze the test data.Results: 1.There were no significant differences in general data and preoperative coagulation indexes between the two groups(P > 0.05).(2)There was a significant difference in the volume of chest drainage in 24 hours between the two groups(P < 0.05).(3)There was a significant difference in heparin residue between the HDR(heparin dose response curve)group(0.51(-0.58-0.85)min)and the control group(2.32(0.45-3.83)min)(P< 0.05).(4)The TEG parameters of common cup and heparanase in the HDR-based regimen group were not significantly different from those in the control group(P > 0.05),and the parameters were basically in the normal range.(5)There was no significant difference in ACT between HDR-based regimen group 144(132-180)s and control group 146(136-154)s(P > 0.05).Conclusion: Protamine administration based on heparin dose-response curve can reduce postoperative blood loss and improve postoperative heparin residue.The results showed that the residual heparin after neutralization of protamin was better than that of ACT. |
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