术后房颤与高剂量比的蛋白蛋白-肝素的关系。

Q2 Health Professions Journal of Extra-Corporeal Technology Pub Date : 2023-03-01 DOI:10.1051/ject/2023003
Yasuharu Yamada, Junzo Iemura, Atushi Kambara, Noboru Tateishi, Yuji Kozaki, Masako Yamada, Junko Maruyama, Eiichi Azuma
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摘要

背景:术后心房颤动(POAF)被定义为术后立即发生的新发房颤。心脏手术后POAF的发病率相对较高,但POAF的发生、维持和进展的病理生理机制可能是多因素的,尚未得到全面的描述。其中一种机制包括Ca2+动力学的改变。越来越多的证据表明,心房胞质钙处理的改变有助于POAF的发展,鱼精蛋白可逆地调节钙释放通道/ryanodine受体2 (RyR2)和电压依赖性心脏RyR2。然而,目前尚不清楚这种异常是否会导致心律失常底物易使患者发生POAF。方法:我们回顾性分析了147例在体外循环支持下接受心脏手术的患者。其中,有40名患者因先前存在房颤而被排除在分析之外。所有患者均接受肝素治疗,随后又接受鱼精蛋白治疗,根据研究时期不同,鱼精蛋白与肝素的剂量比也不同。结果:将蛋白蛋白与肝素的给药比= 1.0与蛋白蛋白与肝素的给药比>1.0 ~ 1.7进行比较。15例患者发生POAF(15/107 = 14%),其中,57例患者中有5例(33.3%)在蛋白蛋白与肝素的剂量比= 1.0,35例患者中有10例(66.7%)在蛋白蛋白与肝素的剂量比较高。蛋白蛋白与肝素给药比较高的患者与蛋白蛋白与肝素给药比= 1.0的患者相比,差异有统计学意义(优势比= 3.890,95% CI = 1.130 ~ 13.300, p值= 0.031)。当根据较高的蛋白蛋白与肝素剂量比分析疾病类型时,只有瓣膜疾病与POAF显著相关(p = 0.04)。结论:鱼精蛋白在临床上用于逆转肝素过量,并已显示出免疫和炎症改变。然而,其与POAF的关系尚未见报道。我们的结果提供了证据,高剂量比例的蛋白蛋白与肝素可能增加POAF的发生率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Association of postoperative atrial fibrillation with higher dosing ratios of protamine-to-heparin.

Background: Postoperative atrial fibrillation (POAF) is defined as new-onset AF in the immediate postoperative period. The relatively high incidence of POAF after cardiac surgery is well described, but pathophysiological mechanisms underlying the initiation, maintenance, and progression of POAF may be multifactorial and have not yet been comprehensively characterized. One of the mechanisms includes altered Ca2+ kinetics. Accumulating evidence has suggested that altered atrial cytosolic calcium handling contributes to the development of POAF, protamine reversibly modulates the calcium release channel/ryanodine receptor 2 (RyR2) and voltage-dependent cardiac RyR2. However, it is currently unknown whether such abnormalities contribute to the arrhythmogenic substrate predisposing patients to the development of POAF. Methods: We have retrospectively analyzed 147 patients who underwent cardiac surgery with cardiopulmonary bypass support. Of these, 40 patients were excluded from the analysis because of pre-existing AF. All patients received heparin followed by protamine at different dosing ratios of protamine-to-heparin, depending on the periods studied. Results: The dosing ratio of protamine-to-heparin = 1.0 was compared with higher dosing ratios of protamine-to-heparin >1.0 up to 1.7. POAF developed in 15 patients (15/107 = 14%), of these, 5 out of 57 patients (33.3%) in the dosing ratio of protamine-to-heparin = 1.0 and 10 out of 35 patients (66.7%) in the higher dosing ratios of protamine-to-heparin. Statistical significance was observed in patients with higher dosing ratios of protamine-to-heparin, compared with the dosing ratio of protamine-to-heparin = 1.0 (odds ratio = 3.890, 95% CI = 1.130-13.300, p-value = 0.031). When types of diseases were analyzed in terms of higher dosing ratios of protamine-to-heparin, only valvular disorders were significantly associated with POAF (p = 0.04). Conclusions: Protamine is clinically utilized to reverse heparin overdose and has been shown to display immunological and inflammatory alterations. However, its association with POAF has not been reported. Our results provide evidence that higher dosing ratios of protamine-to-heparin may increase the incidence of POAF.

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来源期刊
Journal of Extra-Corporeal Technology
Journal of Extra-Corporeal Technology Medicine-Medicine (all)
CiteScore
1.90
自引率
0.00%
发文量
12
期刊介绍: The Journal of Extracorporeal Technology is dedicated to the study and practice of Basic Science and Clinical issues related to extracorporeal circulation. Areas emphasized in the Journal include: •Cardiopulmonary Bypass •Cardiac Surgery •Cardiovascular Anesthesia •Hematology •Blood Management •Physiology •Fluid Dynamics •Laboratory Science •Coagulation and Hematology •Transfusion •Business Practices •Pediatric Perfusion •Total Quality Management • Evidence-Based Practices
期刊最新文献
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