Reasons and treatment measures of heparin resistance in nineteen patients undergoing cardiac surgery during cardiopulmonary bypass / 重庆医科大学学报

ABSTRACT

Objective:To investigate the reasons and treatment measures of heparin resisitance in patients undergoing cardiac surgery during cardiopulmonary bypass(CPB).Methods:Retrospective analysis of 1 258 patients undergoing cardiac surgery was made.Results: After 400 U/kg heparin was injected intravenously,the activated clotting time(ACT)could not be extended to 480 seconds or was shortened soon after extended to 480 seconds in nineteen patients(1.51%)including seven patients with cardiac myxoma,three patients with rheumatic heart disease,three patients with infective endocarditis patients,two cases of atrial septal defect patients,two cases of tetralogy of Fallot patients,one cases of ventricular septal defect patient and one cases of double outlet right ventricle patient.A large number of heparin was added to maintain ACT at safe range for anticoagulation.But it was invalid for five patients to add heparin,and then ACT could be extended to 480 seconds after 400～600 ml fresh frezon plasma or blood was transfused.Conclusion:Heparin resistance was commonly encountered in cardiac myxoma,infective endocarditis and cyanotic heart diseases requiring CPB.It was associated with the appearance of similar heparin mucopolysaccharide material in the blood,decrease of antithrombinⅢ(ATⅢ)content and activity,increase of platelet count,preoperative anticoagulant therapy and the use of contraceptives.ACT should be monitored frequently during CPB.