The Dose-response Curve Of Heparin Of CHD Patients And The Study Of The Dose Of Heparin Before Cardiopulmonary Bypass(CPB)

Heparin anticoagulation is a very important procedure beforecardiopulmonary bypass(CPB),more or less directly affects the recoveryof the patients. If we admitted heparin as traditional methods ,much morepatients will accept excessive anticoagulation(ACT over normal rangeexcessively).This article include two parts:The first one studies theACT of CHD patients whenvarious dose of heparin administration, aims toprobe the minimal heparin dose for CHD patients before CPE. The secondone studies the relationship between heparin dose and chest tube drainageoutcomes.The first part:OBJECTIVE: to draw the mass dose-reaction curve of heparin of eNDpatients and calculate the minimal heparin dose when ACT reaches 480second and 750 second. METHODS:sixty-eight CHD patients are assignedrandomly into six groups, monitor invasive blood pressure, introductionand intubation monitor central venous pressure. 2ml blood from centralvenous is added into test tube which is prewarmed into 37℃. The bloodis then mixed by a manual, gradual shaking of the tube, put the test tubeinto the ACT monitor, record the physiological ACT. Monitor ACT beforecardiopulmonary bypass, hepain dose admitted to the six groups fromcentral venous before cardiopulmonary bypass was 0.5mg/kg, 1 mg/kg,1.5 mg/kg, 2 mg/kg, 2.5 mg/kg, 3 mg/kg iv, monitor ACT after 300seconds, supply the heparin until 2.5 mg/kg or 3mg/kg, monitor ACT after300 seconds repeatedly. Record theage, weight, height, rbc, hgb, hct, plt, pt, apt, tt, fib of everpatient.SPSS11.5 is used to accomplish the statistic analysis. RESULTS: the mass dose-reaction curve of heparin of CHD patients is ACT=190.38*HEPARIN+114.71 (r=0.8991). the heparin dose when ACT reaches 480 secondand 750 second are 1.92±0.13mg/kg and 3.337±0.263 mg/kg. Theage, weight, height, rbc, hgb, hct, plt, pt, apt, tt, fib of the patients in evergroup have no statistic diversity. CONCLUSIONS: we can analyse therelation between heparindose and ACT, and draw the conclusion that theminimal heparin dose when ACT reaches 480 second and 750 second are 2.05mg/kg and 3.6 mg/kg.The second part:OBJECTIVE: to probe the relations between the heparin dose admittedto the patients and the quality of the chest tube drainage. METHODS: survey27 patients who admitted cardiac surgery, record the total heparin doseadmitted to the patients(including during CPB and post CPB) and thequality of the chest tube drainage. SPSS11.5 is used to accomplish thestatistic analysis. RESULTS: there is less relations between the totalheparin dose and the quality of the chest tube drainage(r=0.331).CONCLUSIONS:there are much factors affect the quality of the chest tubedrainage, including:surgery hemostasis, the time of operation, the timeof cardiopulmonary bypass, protaminedose after cardiopulmonarybypass,hemostatic using and the self conditions of the patients, so if we merelyprobe the relations between the heparin dose admitted to the patientsand the quality of the chest tube drainage, there is lessrelations, multiple statistic analysis is necessary to probe thisquestion.