Punjabi P P, Wyse R K, Taylor K M
Department of Cardiothoracic Surgery, NHLI, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK.
Expert Opin Pharmacother. 2000 Dec;1(7):1353-65. doi: 10.1517/14656566.1.7.1353.
Management of patients undergoing cardiac surgery has evolved in recent years as more is understood about the physiological changes and responses that occur during and after cardiopulmonary bypass (CPB). In particular, our understanding of the mechanisms involved in haemostasis and in the inflammatory response to bypass surgery, has allowed significant refinements in patient management. Improvements in the pharmacological conservation of blood loss have been striking, particularly with the development of the serine protease inhibitor, aprotinin (Trasylol, Bayer). Aprotinin represents a significant improvement, especially for patients at high risk, since it reduces the need for allogeneic and (sometimes scarce) blood products. However, in view of its cost, making an appropriate selection of patients most at risk of serious blood loss is a major consideration in the use of aprotinin. While its mechanisms of action are not well understood, the use of aprotinin also appears to reduce inflammatory response to CPB.
近年来，随着我们对心肺转流术（CPB）期间及之后发生的生理变化和反应有了更多了解，接受心脏手术患者的管理方式也有所演变。特别是，我们对止血机制以及对体外循环手术炎症反应的理解，使得患者管理有了显著改进。在减少失血的药物应用方面取得了显著进展，尤其是随着丝氨酸蛋白酶抑制剂抑肽酶（特血乐，拜耳公司）的研发。抑肽酶代表了一项重大进步，特别是对于高危患者，因为它减少了对异体（有时稀缺）血液制品的需求。然而，鉴于其成本，在使用抑肽酶时，合理选择最有严重失血风险的患者是一个主要考虑因素。虽然其作用机制尚未完全了解，但使用抑肽酶似乎也能减轻对CPB的炎症反应。
