体外循环心内直视手术中鱼精蛋白致严重循环抑制的治疗_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

杨灿 ¹ , 邵博明 ¹ , 孙青 ¹ , 朱巍 ¹ , 崔士和 ¹ , 王喆妍 ¹ , 任云 ² ,  骆璇 ²

1. ;
2. ;

Corresponding author：

骆璇, Email: xuanxuan10507@sina.com

Keywords：

鱼精蛋白; 毒性反应; 循环抑制; 体外循环

DOI：

10.7507/1007-4848.201707052

Video：

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目的总结体外循环心内直视手术中鱼精蛋白所致严重循环抑制的救治经验。方法回顾性分析 2016 年 6 月至 2017 年 7 月我中心体外循环心内直视手术中给予鱼精蛋白中和肝素后出现严重循环抑制 9 例患者的临床资料，其中男 7 例，女 2 例，年龄 62.3（36～78）岁。7 例为左心室肥厚者。分析其临床特点及处理方法。结果 1 例因反复给予鱼精蛋白而循环衰竭死亡，1 例因非鱼精蛋白原因死亡，余 7 例经肝素化转机和/或垂体后叶素等血管活性药抢救后好转。结论鱼精蛋白毒性反应所导致的严重循环抑制为突发事件且往往危及生命，果断肝素化转机和垂体后叶素的及时应用是成功挽救患者生命的重要环节。

Citation： 杨灿, 邵博明, 孙青, 朱巍, 崔士和, 王喆妍, 任云, 骆璇. 体外循环心内直视手术中鱼精蛋白致严重循环抑制的治疗. 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.	杨彦博, 任旭东, 张巧燕, 等. 不同途径中和肝素对先天性心脏病合并肺动脉高压术后肺循环的影响. 重庆医学, 2013, 42(34): 4152-4154.
11.	张为民, 申伟林, 张帅, 等. 小量预注法预防鱼精蛋白毒性反应的临床观察. 中国社区医师, 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. 方强, 石应康, 张尔永, 等. 心内直视术中鱼精蛋白毒副反应的危险因素分析. 中国胸心血管外科临床杂志, 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. 陈永福, 罗业春, 覃祖光. 体外循环术后不同途径输注鱼精蛋白对血流动力学的影响. 中国现代药物应用, 2015, 9(5): 103-104.
10. 杨彦博, 任旭东, 张巧燕, 等. 不同途径中和肝素对先天性心脏病合并肺动脉高压术后肺循环的影响. 重庆医学, 2013, 42(34): 4152-4154.
11. 张为民, 申伟林, 张帅, 等. 小量预注法预防鱼精蛋白毒性反应的临床观察. 中国社区医师, 2013, 15(20): 18-19.
12. 陈青云, 华东, 郑和平. 氯化钙预防鱼精蛋白不良反应临床观察. 罕少疾病杂志, 2013, 20(3): 37-41.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

体外循环心内直视手术中鱼精蛋白致严重循环抑制的治疗

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