Vedrinne C, Girard C, Jegaden O, Blanc P, Bouvier H, Ffrench P, Mikaeloff P, Estanove S
Department of Anesthesiology and Intensive Care, Hôpital Cardiologique Louis Pradel, Lepine, France.
J Cardiothorac Vasc Anesth. 1992 Jun;6(3):319-23. doi: 10.1016/1053-0770(92)90149-2.
Ninety patients undergoing cardiac surgery were randomly divided into three groups of 30 patients to compare the effects on bleeding and transfusion requirements of either intraoperative infusion of high-dose aprotinin (GpI) or reinfusion of autologous fresh whole blood (GpII) versus a control group (GpIII). Standardized anesthetic, perfusion, and surgical techniques were used. Platelet counts, hemoglobin concentration, hematocrit, fibrinogen, and Ivy-Nelson bleeding times determined at fixed times perioperatively did not differ among the three groups. The total loss from the chest drains was significantly reduced in GpI (328 +/- 28 mL; mean +/- SEM) as compared with the loss in GpII and GpIII (775 +/- 75 mL and 834 +/- 68 mL, respectively). There was a threefold difference in the total hemoglobin loss (GpI, 14.2 +/- 1.7 g; GpII, 50.1 +/- 5.0 g; GpIII, 45.0 +/- 5.2 g). GpI patients also received less banked blood: 250 +/- 53 mL versus 507 +/- 95 mL in GpII and 557 +/- 75 mL in GpIII. No GpI patient required transfusion of platelets or fresh frozen plasma. Fresh whole autologous blood transfusions had no significant hemostatic effect and failed to reduce the homologous blood requirement. Conversely, high-dose aprotinin reduced blood loss and transfusion requirements.
90例行心脏手术的患者被随机分为三组，每组30例，以比较术中输注大剂量抑肽酶（第一组）或自体新鲜全血回输（第二组）与对照组（第三组）对出血及输血需求的影响。采用标准化的麻醉、灌注和手术技术。三组患者围手术期固定时间点测定的血小板计数、血红蛋白浓度、血细胞比容、纤维蛋白原及Ivy-Nelson出血时间无差异。与第二组和第三组（分别为775±75ml和834±68ml）相比，第一组胸腔引流管的总失血量显著减少（328±28ml）。总血红蛋白丢失量有三倍差异（第一组，14.2±1.7g；第二组，50.1±5.0g；第三组，45.0±5.2g）。第一组患者输注的库存血也较少：250±53ml，而第二组为507±95ml，第三组为557±75ml。第一组患者均无需输注血小板或新鲜冰冻血浆。自体新鲜全血回输无显著止血作用，也未能减少异体血需求。相反，大剂量抑肽酶可减少失血量和输血需求。
