POCT即时检验PPT学习教案

1、会计学1POCT即时检验即时检验第1页/共46页第2页/共46页Why Point-Ong?第3页/共46页第4页/共46页Immediate Turn ArouLab (min) MedianCPB (N=40)90.0PVS (N=45)90.0Mean78.574.0Minimum38.021.0POC (min)MedianAll Groups2.23Minimum0.33Maximum6.97第5页/共46页第6页/共46页nOthers第7页/共46页第8页/共46页第9页/共46页Maintain BalanceBleeding ThrombosisHeparinRapid An

2、ticoagulant EffectIndividual sensitivities vary significantlyPotency differencesSource: Bovine or PorcineLot to Lot variabilityRapidly Reversible with Protamine第10页/共46页0100200300400500600700012345Heparin (units/ml)Clotting Time (sec)C-ACTK-ACTACT+P214ACT-LRCCUDialysisCATHPTCACPB第11页/共46页Monitoring

3、第12页/共46页Monitoring 第13页/共46页01002003004005006007008009001000BaselinePostBolusPostBolus2OnPumpOnPump2OnPump3PostProt.Clotting TimeKaolin ACTCelite ACTACT+第14页/共46页Pediatric Cardiac Surgery0100200300400500600700baselinepost-boluson pumprewarmpost-CPBtime during bypassClotting time (sec)FTCA510ACT+第15

4、页/共46页Pharmaceutition第16页/共46页Pharmaceutition第17页/共46页aprotininnUsed with target times of 400 seconds第18页/共46页020040060080010001200BaselinePostBolusPostBolus2OnPumpOnPump2OnPump3PostProt.Clotting Time .Kaolin ACTCelite ACTACT+Data from clinical evaluation, on file, ITC第19页/共46页第20页/共46页lWhy is manag

5、ement important?Traditional dosing regimens recommend fixed drug doses by body weight. For most patients, this regimen provides adequate anticoagulation.lRegimen does not account for patients whose response to heparin is different than the average patient.Patients differ in their response to heparin

6、; some patients may be resistant or sensitive to heparinlThey can represent 20 - 40% of patient population第21页/共46页lHeparin Resistance: Repeated exposure to heparin (from previous procedures) may reduce patients response to the druglPatient requires a higher dose of heparin in order to obtain the sa

7、me anticoagulant effect第22页/共46页lHeparin Sensitivity: Patients response to heparin is greater than the average patient of the same height, weight and gender. lPatient requires a lower heparin dose to obtain the same anticoagulant effect.第23页/共46页lBenefits:Individualizes heparin dose for sensitive an

8、d resistant patientsReduces use of blood products needed for post-operative transfusionslJOBES DR, et al. 1995. INCREASED ACCURACY AND PRECISION OF HEPARIN AND PROTAMINE DOSING REDUCES BLOOD LOSS AND TRANSFUSION REQUIREMENTS IN PATIENTS UNDERGOING PRIMARY CARDIAC OPERATIONS. J THORAC CARDIOVASC SURG

9、 110: 36-45 第24页/共46页lBenefits:Reduces potential for protamine dose side effectslProtamine reduced by average of 30%ZUCKER ML., et al. 1997. UTILITY OF IN VITRO HEPARIN AND PROTAMINE TITRATION FOR DOSING DURING CARDIOPULMONARY BYPASS SURGERY. J EXTRA-CORP TECH. 29: 176-180.Cost SavingsJOBES D, et al

10、. 1996. COST EFFECTIVE MANAGEMENT OF HEPARIN/PROTAMINE IN CP BYPASS: ANALYSIS BY TYPE OF SURGERY. ANESTHES 85: 3A第25页/共46页第26页/共46页Mtg.第27页/共46页第28页/共46页第29页/共46页nTarget times determined by each facilitynTargets usually set as 1.5-2x baseline ACT values (180 - 240 seconds).第30页/共46页nMonitor during h

11、eparin / coumadin cross-over第31页/共46页Heparin venDrugActionMechan-ismMoni-toringEffectiveHeparinDirectInhibition ofThrombinATIIIcofactorAPTTACTImmediateWarfarinDecreasesProductionof factorsVitamin KPTDelay3-5 days第32页/共46页ISImeannormalpatientPTPTINR第33页/共46页第34页/共46页第35页/共46页Dade Actin / MLAy = 0.72x

12、 + 11.5R = 0.883203040506070203040506070labSignatureIL aPTT SP / ACL #2y = 0.59x + 16.0R = 0.96110.030.050.070.090.0110.0130.0150.01030507090110130150labSignatureIL aPTT C / ACL #3y = 0.44x + 22.2R = 0.953310.030.050.070.090.0110.0130.0150.01030507090110130150labSignatureOrganon Technika / MDAy = 1.02x + 4.1R = 0.942203040506070203040506070labSignature第36页/共46页y = 0.578x + 0.7994R2 = 0.9238R=.9611012345678024681012Hospital INRSignature INR第37页/共46页第38页/共46页Efficacy (Kt/V)nOuseph, R. et.al. Am J Ki