Mohr R, Goor D A, Lusky A, Lavee J
Department of Cardiac Surgery and Epidemiology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Circulation. 1992 Nov;86(5 Suppl):II405-9.
Administration of aprotinin during extracorporeal circulation reduces blood loss and improves platelet function.
To evaluate the protective effect of aprotinin on platelets, 50 patients undergoing cardiopulmonary bypass were randomized before surgery to one of three groups. Seventeen patients (group A) received continuous high-dose aprotinin (7 x 10(6) KIU) during cardiopulmonary bypass, 17 (group B) received a single bolus of aprotinin in the pump prime (2 x 10(6) KIU), and 16 (group C) received placebo. Scanning electron microscopy was used to evaluate platelet aggregation on extracellular matrix. The platelet function was graded from 1 to 4, with grade 4 being normal aggregation. Immediately after cardiopulmonary bypass, 16 patients in group A (94%) reached preoperative aggregation grade (mean grade, 3.4 +/- 0.7) compared with nine of 17 in group B (52%) (mean grade, 2.9 +/- 1.2), and none in group C (0%) (mean grade, 1.4 +/- 0.5; p < 0.001). Postoperative platelet count did not differ significantly among the three groups. After surgery, group A bled less than groups B and C (395 +/- 120 versus 488 +/- 135 and 780 +/- 408 ml, respectively; p < 0.01). Patients in the aprotinin groups received fewer red blood cell units (0.9 +/- 1.2 and 1.9 +/- 1.2 versus 3.4 +/- 1.9, respectively; p < 0.01) and were exposed to less homologous blood products (1.3 +/- 1.7 and 2.1 +/- 1.1 versus 6.1 +/- 5, respectively; p < 0.001).
By preserving platelet function, aprotinin improves postoperative hemostasis in all patients who receive high dose and in most who receive low dose.
体外循环期间给予抑肽酶可减少失血并改善血小板功能。
为评估抑肽酶对血小板的保护作用，50例接受心肺转流术的患者在手术前被随机分为三组。17例患者（A组）在心肺转流期间接受持续高剂量抑肽酶（7×10⁶KIU），17例（B组）在预充液中接受单次大剂量抑肽酶（2×10⁶KIU），16例（C组）接受安慰剂。采用扫描电子显微镜评估细胞外基质上的血小板聚集情况。血小板功能按1至4级分级，4级为正常聚集。心肺转流后即刻，A组16例患者（94%）达到术前聚集分级（平均分级，3.4±0.7），而B组17例中有9例（52%）（平均分级，2.9±1.2），C组无一例（0%）（平均分级，1.4±0.5；p<0.001）。三组术后血小板计数无显著差异。术后，A组失血量少于B组和C组（分别为395±120ml、488±135ml和780±408ml；p<0.01）。抑肽酶组患者接受的红细胞单位较少（分别为0.9±1.2和1.9±1.2，而3.4±1.9；p<0.01），且接触的同源血制品较少（分别为1.3±1.7和2.1±1.1，而6.1±5；p<0.001）。
通过保留血小板功能，抑肽酶可改善所有接受高剂量及大多数接受低剂量抑肽酶患者的术后止血情况。
