低剂量术后抑肽酶可减少正在服用阿司匹林的初次冠状动脉搭桥术患者的纵隔引流及血制品使用：一项前瞻性、随机、双盲、安慰剂对照试验。

Low-dose postoperative aprotinin reduces mediastinal drainage and blood product use in patients undergoing primary coronary artery bypass grafting who are taking aspirin: a prospective, randomized, double-blind, placebo-controlled trial.

作者信息

Alvarez J M, Jackson L R, Chatwin C, Smolich J J

机构信息

Cardiothoracic Surgery Unit, Monash Medical Centre, Department of Medicine, Monash University, Clayton, Victoria, Australia.

出版信息

J Thorac Cardiovasc Surg. 2001 Sep;122(3):457-63. doi: 10.1067/mtc.2001.115701.

DOI:10.1067/mtc.2001.115701

PMID:11547294

Abstract

BACKGROUND

Although low-dose aprotinin administered after cardiopulmonary bypass has been reported to reduce mediastinal blood loss and blood product requirements in patients not taking aspirin, it is unknown whether low-dose postoperative aprotinin has any beneficial effects in patients undergoing coronary artery bypass operations who are at high risk of excessive postoperative bleeding and increased transfusion requirements because of aspirin use until just before the operation.

METHODS

Fifty-five patients undergoing primary coronary artery operations with cardiopulmonary bypass who continued taking aspirin (150 mg/d) until the day before the operation were enrolled in a prospective, randomized, double-blind trial to receive a single dose of either placebo (n = 29) or 2 x 10(6) kallikrein inhibiting units of aprotinin (n = 26) at the time of sternal skin closure.

RESULTS

Patients in the aprotinin group had a lower rate (28 +/- 18 vs 43 +/- 21 mL/h [mean +/- standard deviation], P <.005) and total volume of mediastinal drainage (955 +/- 615 vs 1570 +/- 955 mL, P <.007), as well as a shorter duration of mediastinal drain tube insertion (24.4 +/- 13.8 vs 31.3 +/- 16.5 hours, P <.05). In addition, a smaller proportion of patients receiving aprotinin required a blood product (31% vs 62%, P =.03), resulting in a reduction in the use of packed cells by 47% (P =.05), platelets by 77% (P =.01), fresh frozen plasma by 88% (P =.03), and total blood products by 68% (P =.01) in this group.

CONCLUSIONS

These results suggest that postoperative administration of low-dose aprotinin in patients taking aspirin until just before primary coronary artery operations with cardiopulmonary bypass not only reduces the rate and total amount of postoperative mediastinal blood loss but also lowers postoperative blood product use.

摘要

背景

尽管有报道称，在体外循环后给予低剂量抑肽酶可减少未服用阿司匹林患者的纵隔失血及血制品需求，但对于因术前一直服用阿司匹林而术后出血过多和输血需求增加风险较高的冠状动脉搭桥手术患者，术后给予低剂量抑肽酶是否有任何有益作用尚不清楚。

方法

55例接受体外循环下初次冠状动脉手术且术前一直服用阿司匹林（150mg/d）至手术前一天的患者，被纳入一项前瞻性、随机、双盲试验，在胸骨皮肤缝合时接受单剂量安慰剂（n = 29）或2×10⁶激肽释放酶抑制单位的抑肽酶（n = 26）。

结果

抑肽酶组患者纵隔引流量的速率（28±18 vs 43±21ml/h[均值±标准差]，P<.005）和总量（955±615 vs 1570±955ml，P<.007）均较低，纵隔引流管留置时间也较短（24.4±13.8 vs 31.3±16.5小时，P<.05）。此外，接受抑肽酶治疗的患者中需要血制品的比例较小（31% vs 62%，P =.03），该组浓缩红细胞使用量减少47%（P =.05），血小板减少77%（P =.01），新鲜冰冻血浆减少88%（P =.03），全血制品减少68%（P =.01）。