體外循環心內直視手術中魚精蛋白致嚴重循環抑制的治療_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

楊燦 ¹ , 邵博明 ¹ , 孫青 ¹ , 朱巍 ¹ , 崔士和 ¹ , 王喆妍 ¹ , 任云 ² ,  駱璇 ²

1. ;
2. ;

Corresponding?author：

駱璇, Email: xuanxuan10507@sina.com

Keywords：

魚精蛋白; 毒性反應; 循環抑制; 體外循環

DOI：

10.7507/1007-4848.201707052

Video：

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目的總結體外循環心內直視手術中魚精蛋白所致嚴重循環抑制的救治經驗。方法回顧性分析 2016 年 6 月至 2017 年 7 月我中心體外循環心內直視手術中給予魚精蛋白中和肝素后出現嚴重循環抑制 9 例患者的臨床資料，其中男 7 例，女 2 例，年齡 62.3（36～78）歲。7 例為左心室肥厚者。分析其臨床特點及處理方法。結果 1 例因反復給予魚精蛋白而循環衰竭死亡，1 例因非魚精蛋白原因死亡，余 7 例經肝素化轉機和/或垂體后葉素等血管活性藥搶救后好轉。結論魚精蛋白毒性反應所導致的嚴重循環抑制為突發事件且往往危及生命，果斷肝素化轉機和垂體后葉素的及時應用是成功挽救患者生命的重要環節。

Citation： 楊燦, 邵博明, 孫青, 朱巍, 崔士和, 王喆妍, 任云, 駱璇. 體外循環心內直視手術中魚精蛋白致嚴重循環抑制的治療. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(7): 633-635. doi: 10.7507/1007-4848.201707052 Copy

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10.	楊彥博, 任旭東, 張巧燕, 等. 不同途徑中和肝素對先天性心臟病合并肺動脈高壓術后肺循環的影響. 重慶醫學, 2013, 42(34): 4152-4154.
11.	張為民, 申偉林, 張帥, 等. 小量預注法預防魚精蛋白毒性反應的臨床觀察. 中國社區醫師, 2013, 15(20): 18-19.
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1. Welsby IJ, Newman MF, Phillips-Bute B, et al. Hemodynamic changes after protamine administration: association with mortality after coronary artery bypass surgery. Anesthesiology, 2005, 102(2): 308-314.
2. Kimmel SE, Sekeres M, Berlin JA, et al. Mortality and adverse events after protamine administration in patients undergoing cardiopulmonary bypass. Anesth Analg, 2002, 94(6): 1402-1408.
3. Raikar GV, Hisamochi K, Raikar BL, et al. Nitric oxide inhibition attenuates systemic hypotension produced by protamine. J Thorac Cardiovasc Surg, 1996, 111(6): 1240-1246.
4. Kalathottukaren MT, Abraham L, Kapopara PR, et al. Alteration of blood clotting and lung damage by protamine are avoided using the heparin and polyphosphate inhibitor UHRA. Blood, 2017, 129(10): 1368-1379.
5. Sommers CD, Ye H, Liu J, et al. Heparin and homogeneous model heparin oligosaccharides form distinct complexes with protamine: Light scattering and zeta potential analysis. J Pharm Biomed Anal, 2017, 140: 113-121.
6. 方強, 石應康, 張爾永, 等. 心內直視術中魚精蛋白毒副反應的危險因素分析. 中國胸心血管外科臨床雜志, 2003, 10(3): 177-180.
7. Gueugniaud PY, David JS, Chanzy E, et al. Vasopressin and epinephrine vs. epinephrine alone in cardiopulmonary resuscitation. N Engl J Med, 2008, 359(1): 21-30.
8. Fulton LV, Aitken J, Avery J, et al. Comparative resuscitative methods for venlafaxine toxicity in a swine model. Mil Med, 2016, 181(4): 383-388.
9. 陳永福, 羅業春, 覃祖光. 體外循環術后不同途徑輸注魚精蛋白對血流動力學的影響. 中國現代藥物應用, 2015, 9(5): 103-104.
10. 楊彥博, 任旭東, 張巧燕, 等. 不同途徑中和肝素對先天性心臟病合并肺動脈高壓術后肺循環的影響. 重慶醫學, 2013, 42(34): 4152-4154.
11. 張為民, 申偉林, 張帥, 等. 小量預注法預防魚精蛋白毒性反應的臨床觀察. 中國社區醫師, 2013, 15(20): 18-19.
12. 陳青云, 華東, 鄭和平. 氯化鈣預防魚精蛋白不良反應臨床觀察. 罕少疾病雜志, 2013, 20(3): 37-41.

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體外循環心內直視手術中魚精蛋白致嚴重循環抑制的治療

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