Ray M J, O'Brien M F
Department of Haematology, Queensland Health Pathology Service, The Prince Charles Hospital, Brisbane, Australia.
Ann Thorac Surg. 2001 Mar;71(3):838-43. doi: 10.1016/s0003-4975(00)02229-3.
In this study we compared the clinical efficiency, safety, and economic benefit of low-dose aprotinin with epsilon aminocaproic acid (EACA) in reducing bleeding after cardiopulmonary bypass operation.
In a double-blind, randomized study, 100 patients received low-dose aprotinin (2 x 10(6) kallikrein inhibitor units) or EACA (20 g). The surgical procedure was single- or double-valve replacement with or without coronary artery bypass grafts.
Mediastinal chest drainage and transfusion requirements with both therapies were similar. There were no urgent reoperations to secure hemostasis in either group. Similar levels of D-dimer with both therapies indicate a similar inhibition of fibrinolysis. Release of troponin I was less in the low-dose aprotinin group 1 and 4 hours after bypass, although electrocardiographic measurements did not reflect this difference. Levels of S-100beta and neuron-specific enolase were similar with both therapies, confirming that there was no difference in the occurrence of any adverse neurologic events in either group.
Low-dose aprotinin and EACA showed similar effects on the reduction of intraoperative and postoperative bleeding. The lower cost of EACA with no change in safety outcome suggests it is the preferred treatment.
在本研究中，我们比较了低剂量抑肽酶与ε-氨基己酸（EACA）在减少体外循环手术后出血方面的临床疗效、安全性和经济效益。
在一项双盲随机研究中，100例患者接受低剂量抑肽酶（2×10⁶激肽释放酶抑制单位）或EACA（20 g）治疗。手术方式为单瓣膜或双瓣膜置换术，可伴有或不伴有冠状动脉搭桥术。
两种治疗方法的纵隔胸腔引流量和输血量相似。两组均无因止血而进行的紧急再次手术。两种治疗方法的D-二聚体水平相似，表明纤维蛋白溶解抑制程度相似。尽管心电图测量未反映出这种差异，但在体外循环后1小时和4小时，低剂量抑肽酶组的肌钙蛋白I释放量较少。两种治疗方法的S-100β和神经元特异性烯醇化酶水平相似，证实两组在任何不良神经事件的发生率上没有差异。
低剂量抑肽酶和EACA在减少术中和术后出血方面显示出相似的效果。EACA成本较低且安全结果无变化，表明它是首选治疗方法。
