Rentoul Toni M, Harrison Victor L, Shun Albert
Department of Anesthesia and Department of Surgery, The Children's Hospital at Westmead, Westmead, Australia.
Pediatr Transplant. 2003 Apr;7(2):142-8. doi: 10.1034/j.1399-3046.2003.00037.x.
The use of aprotinin to reduce blood loss by inhibiting fibrinolysis thereby decreasing transfusion requirements during orthotopic liver transplantation (OLT), is well-documented in adults. We set out to test the hypothesis that the prophylactic use of aprotinin reduced blood product requirements during pediatric OLT. A retrospective study was performed, reviewing data from 24 OLTs performed over a 4-yr period. Six patients did not receive aprotinin (group 1), while 18 (group 2) received a weight-based dose of aprotinin. Both groups were comparable with respect to demographics, baseline characteristics and surgical variables except for a significantly more prolonged activated partial thromboplastin time (APTT) in the aprotinin group (p = 0.015). Despite the fact that median values for transfused volumes of red blood cells (78.3 vs. 36.7 mL/kg) and fresh frozen plasma (51.9 vs. 23.7 mL/kg) were more than halved in the aprotinin group, there was no statistical difference demonstrated. The failure to reach statistical significance can probably be explained by the small number in group 1 and a high level of scatter. All patients in group 1 required intraoperative transfusion of RBC and fresh frozen plasma (FFP) while two patients in group 2 did not require RBC and seven received no FFP. There were four patients in group 1 and 17 in group 2 who did not receive platelets while five in group 1 and 12 in group 2 did not receive cryoprecipitate. The differences between the groups in avoidance of these blood products did not reach statistical significance. There was little difference between groups with respect to albumin and crystalloid requirements. No statistical difference was demonstrated in intraoperative hematologic profiles between the two groups except during the anhepatic phase of surgery when there was a statistically significant more prolonged prothrombin time (p = 0.04) and a greater international normalized ratio (p = 0.027) in group 2.
抑肽酶通过抑制纤维蛋白溶解减少失血从而降低原位肝移植（OLT）期间输血需求，这在成人中已有充分记录。我们着手检验这一假设：预防性使用抑肽酶可降低小儿OLT期间的血液制品需求。进行了一项回顾性研究，回顾了4年期间24例OLT的数据。6例患者未接受抑肽酶（第1组），而18例（第2组）接受了基于体重的抑肽酶剂量。除抑肽酶组活化部分凝血活酶时间（APTT）显著延长外（p = 0.015），两组在人口统计学、基线特征和手术变量方面具有可比性。尽管抑肽酶组红细胞输注量（78.3 vs. 36.7 mL/kg）和新鲜冰冻血浆输注量（51.9 vs. 23.7 mL/kg）的中位数减半以上，但未显示出统计学差异。未能达到统计学显著性可能是由于第1组数量少且离散度高。第1组所有患者术中均需要输注红细胞和新鲜冰冻血浆（FFP），而第2组有2例患者不需要红细胞，7例未接受FFP。第1组有4例患者和第2组有17例患者未接受血小板，第1组有5例患者和第2组有12例患者未接受冷沉淀。两组在避免使用这些血液制品方面的差异未达到统计学显著性。两组在白蛋白和晶体液需求方面差异不大。两组术中血液学指标除在无肝期外无统计学差异，无肝期时第2组凝血酶原时间显著延长（p = 0.04），国际标准化比值更高（p = 0.027）。
