Effeciency Of Agkistrodon Hemocoagulase On Coagulation Function In Patients Underwent Cardiac Valve Replacement With Cardiopulmonary Bypass

Objective:Cardiopulmonary bypass(CPB) can lead to the dysfunction of coagulation fuction. This work aimed to investigate the efficiency and safety of agkistrodon hemocoagulase on the coagulation and fibrinolytic system in patients underwent cardiac valve replacement with CPB.Methods:In this prospective, randomized controlled trial.80 eligible patients who accept cardiac valve replacement were assigned to control group(n=20), and agkistrodon hemocoagulase group (H1, H2, H3 group) according to the different timing of administration, there were 20 patients in each group.30 minute before anesthesia, penehyclidine and morphine were intramuscularly injected in all patients. All patients were conventional monitored with ECG, HR, SpO2, T, BIS, IBP after entering the operating room. Intravenous anesthesia induction medicine are etomidate 0.2-0.4 mg/kg, midazolam 0.08-0.15 mg/kg, fentany 5-7μg/kg, rocuronium 0.7～1 mg/kg. Those operations are performed by experienced anesthesiologist. Anesthesia was maintained with anesthesia medication intravenous injected intermittently. After anesthesia induction, patients in 4 groups were continually ventilated mechanically (Oxygen flow rate:2 L/min, VT:6-8 ml/kg, RR:10～15 b/min, I:E 1:1.5～2). CPB were made up of Jostra HL20 heart-lung machine, microembolus filter and MAQUET membrane oxygenate. The control group and experimental group injected agkistrodon hemocoagulase on time. During CPB, maintain hemodynamic stable with vascular active pharmaceutical. After the surgery, patients were send to intensive care unit (ICU). Monitoring coagulation parameters (activated partial thromboplastin time(APTT)、 thrombin time(TT)、plasma fibrinogen(Fib)、platelet(PLT)), when 20 minutes before anesthesia induction(To), immediately after surgery(T1),24 hours after surgery(T2), and record clinical indexes, such as mediastinal pericardial drainage within 24 hours, secondary thoracotomy, allergies, neuropsychiatric symptoms, and so on.Results:In 4 groups, general data and characteristics of all patients during operation were not considerable change at all time points(P>0.05). PT、APTT、TT、Fib、PLT count difference were statistically significant before and after surgery(P<0.05). PT、 APTT、TT at Ti were higher than To、T2(P<0.05), Fib and PLT count were on the contray. At Ti、T2 time points, PT、APTT and TT in group H1、H2 and H3 were lower than the control group(P<0.05), howeever, they were higher than them in To(P<0.05). Pericardial hemocoagulase mediastinal drainage within 24 hours and the duration of ventilation support was significantly lower than the control group(P<0.05), all patients had no neuropsychiatric symptoms. No difference was seen between the incidence of adverse events among 4 groups.Conclusion:In summary, we draw the following conclusion:Agkistrodon hemocoagulase can improve the abnormal coagulation and fibrinolysis in perioperative and postoperative. It’s safe and effective in patients underwent cardiac valve replacement with cardiopulmonary bypass.