Atropine,Ondansetron,Ketorolac Combined Pre-injection To Prevent Protamine Adverse Reactions

Background At present,there is no unified conclusion on the mechanism of protamine adverse reactions,and the clinical treatment of various drugs has also expressed their own opinions.Therefore,looking for an effective and important preventive medicine.Through the study of the adverse reactions in the prevalence of amniotic fluid embolism.A review of related literature found that fish sperm and amniotic fluid embolism have similar characteristics in clinical manifestations: pulmonary circulation pictures(increased lungs,increased airway pressure),cardio-systemic circulation(decreased blood sugar,low output).Studying the possible prevention of protamine adverse reactions provides a new treatment idea.Objective Observation on the prevention of adverse reactions of protamine neutralizing heparin by combined injection of atropine,ondansetron and ketoprofen(A-OK)after extracorporeal circulation(CPB),compare and analyze the changes of mean arterial pressure,heart rate,central venous pressure,airway pressure,D-dimer,complement C3 and C4 after protamine and heparin,providing a certain reference basis for clinical prevention of adverse reactions of protamine,so as to reduce the incidence of adverse reactions and improve the safety of heart replacement surgery.Methods In 40 patients with marked line of mitral valve replacement,any gender,ages18 to 78 years,ASA Ⅱ ～ Ⅲ level,upon the approval of the hospital ethics committee,and sign the informed consent.Using the random number method,they were randomly divided into two groups(n=40): group A: experimental group;Group B: control group.Venous blood was extracted from patients 5min before and 5min,15 min and 30 min after promycin administration.D-dimer,complement C3 and complement C4 of patients in both groups were measured,and heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP)and airway pressure(PAW)of patients in both groups were recorded.The experimental group received 0.2mg atropine,8mg ondansetron and 15 mg ketoloic acid via central vein at the end of cardiopulmonary bypass before neutralizing heparin in protamine.The control group was injected with raw saline.The hemodynamic indexes,D-dimer and complement C3 and C4 of the two groups were observed before and after protamine administration.Results 1.There was no significant difference in general condition between the two groups(P>0.05).2.There were no significant changes in MAP,CVP,HR,PAW,D-dimer,complement C3 and C4 in experimental groups 5,15 and 30 min after protamine administration compared with 5min before administration(P>0.05).3.In the control group,HR and MAP decreased significantly after 5,15 and 30 min of protamine administration compared with 5min before administration,the difference was statistically significant(P<0.05),CVP,PAW,D-dimer,complement C3 and C4 were significantly increased,and the difference was statistically significant(P<0.05).Conclusion After CPB,combined with preinjection of atropine,ondansetron and ketoloxic acid(A-OK)had little effect on hemodynamic fluctuation after protamine neutralization of heparin,reduced the sharp rise of D-dimer,and improved the rapid change of complement C3 and C4.