Troianos C A, Sypula R W, Lucas D M, D'Amico F, Mathie T B, Desai M, Pasqual R T, Pellegrini R V, Newfeld M L
Department of Anesthesiology, The Mercy Hospital of Pittsburgh, Pennsylvania 15219, USA.
Anesthesiology. 1999 Aug;91(2):430-5. doi: 10.1097/00000542-199908000-00017.
Antifibrinolytic medications administered before skin incision decrease bleeding after cardiac surgery. Numerous case reports indicate thrombus formation with administration of epsilon-aminocaproic acid (epsilon-ACA). The purpose of this study was to examine the efficacy of epsilon-ACA administered after heparinization but before cardiopulmonary bypass in reducing bleeding and transfusion requirements after primary coronary artery bypass surgery.
Seventy-four adult patients undergoing primary coronary artery bypass surgery were randomized to receive 125 mg/kg epsilon-ACA followed by an infusion of 12.5 mg x kg(-1) x h(-1) or an equivalent volume of saline. Coagulation studies, thromboelastography, and platelet aggregation tests were performed preoperatively, after bypass, and on the first postoperative day. Mediastinal drainage was recorded during the 24 h after surgery. Homologous blood transfusion triggers were predefined and transfusion amounts were recorded.
One patient was excluded for surgical bleeding and five patients were excluded for transfusion against predefined criteria One patient died from a dysrhythmia 2 h postoperatively. Among the remaining 67, the epsilon-ACA group had less mediastinal blood loss during the 24 h after surgery, 529+/-241 ml versus 691+/-286 ml (mean +/- SD), P < 0.05, despite longer cardiopulmonary bypass times and lower platelet counts, P < 0.05. Platelet aggregation was reduced in both groups following cardiopulmonary bypass but did not differ between groups. Homologous blood transfusion was similar between both groups.
Prophylactic administration of epsilon-ACA after heparinization but before cardiopulmonary bypass is of minimal benefit for reducing blood loss postoperatively in patients undergoing primary coronary artery bypass grafting.
在皮肤切开前使用抗纤溶药物可减少心脏手术后的出血。大量病例报告表明，使用ε-氨基己酸（ε-ACA）会形成血栓。本研究的目的是检验在肝素化后但在体外循环前给予ε-ACA对减少初次冠状动脉搭桥手术后出血和输血需求的疗效。
74例接受初次冠状动脉搭桥手术的成年患者被随机分为两组，一组接受125mg/kg的ε-ACA，随后以12.5mg·kg⁻¹·h⁻¹的速度输注，另一组接受等量的生理盐水。在术前、体外循环后和术后第一天进行凝血研究、血栓弹力图和血小板聚集试验。记录术后24小时内的纵隔引流量。预先设定了同种异体输血触发标准并记录输血量。
1例患者因手术出血被排除，5例患者因违反预设标准输血被排除。1例患者术后2小时死于心律失常。在其余67例患者中，ε-ACA组术后24小时纵隔失血量较少，为529±241ml，而另一组为691±286ml（均值±标准差），P<0.05，尽管体外循环时间更长且血小板计数更低，P<0.05。体外循环后两组血小板聚集均降低，但两组之间无差异。两组同种异体输血情况相似。
在肝素化后但在体外循环前预防性给予ε-ACA对减少初次冠状动脉搭桥手术患者术后失血的益处极小。
