目的 在常规监测激活全血凝固时间（activated clotting time，ACT）的基础上，应用血栓弹力图（thrombelastography，TEG），对比体外循环心内直视手术中常用鱼精蛋白与肝素中和比例对出凝血的影响。方法 按鱼精蛋白与初始肝素剂量比例随机分为4组：0.6、0.8、1.0、1.3，每组25例。分别记录ACT及TEG 值、肝素残留率、术后引流量、鱼精蛋白不良反应等。结果 （1）四组术后引流量差异无统计学意义。（2）0.6 组中和后TEG 参数呈恶化趋势，与1.3 组差异有统计学意义。（3）肝素残留与鱼精蛋白比例有关，0.6组残留率最高。（4）组内肝素高残留与无残留患者引流量相比，差异有统计学意义。结论 鱼精蛋白与肝素比例≤ 0.8时，肝素残留率较高，出血风险增加。比例为1.0及1.3时，肝素残留率低，未见凝血功能明显损害，出血风险小。

Objective To compare the effects of different ratios of protamine to heparin neutralizationcommonly used in cardiopulmonary bypass（CPB）on coagulation by using thromboelastography（TEG）on the basisof activated clotting time of whole blood（ACT）. Methods According to the dose ratio of protamine to initial heparin，patients were randomly divided into 0.6，0.8，1.0 and 1.3 group，with 25 cases in each group. ACT and TEG values，heparin residual rate，postoperative drainage，and protamine adverse reactions in each group were recorded andcompared. Results （1）There was no significant difference in postoperative drainage of the four groups.（2）TEGparameters of the 0.6 group showed a worsening trend after neutralization，which was statistically different fromthose of the 1.3 group.（3）The residual heparin was related to the proportion of protamine，and the residual rate inthe 0.6 group was the highest.（4）The drainage of patients with high residual heparin and that ofpatients withoutresidual in the same group indicated statistical difference. Conclusions When the ratio of protamine to heparinis ≤ 0.8，the residual rate of heparin is higher，and the bleeding risk increases accordingly.When the ratio is 1.0 or1.3，the residual rate of heparin is low，and there is no obvious damage to the coagulation function，and the risk ofbleeding is low.