Kinzel Vera, Shakespeare David, Derbyshire David
Department of Orthopaedic Surgery, Kimberly House, 3 Lillington Avenue, Leamington Spa CV325 UF, UK.
Knee. 2005 Apr;12(2):107-11. doi: 10.1016/j.knee.2004.03.009.
Twenty-five patients undergoing bilateral total knee arthroplasty were given aprotinin (1-2 million units) in doses adjusted for weight, infused at the end of the first arthroplasty. Blood management was compared with our previous series of 68 patients who were not treated with aprotinin. Blood drained and re-transfused in the first 6 h was significantly less in the aprotinin group (323 ml, S.D. 320) than the untreated group (1033 ml, S.D. 539, p<0.0005). The total blood drained was also less in the aprotinin group (713 ml compared to 1613 ml, p<0.0005) but this was accounted for soley by the difference in early blood loss. The use of other blood products was less in the aprotinin group (360 ml, S.D. 357 compared to 827 ml, S.D. 434, p<0.0005). The mean postoperative haemoglobin on the day following surgery was similar at around 10 g. There were no complications or adverse reactions to the use of aprotinin. We conclude that aprotinin significantly reduces early blood loss after bilateral knee arthroplasty. In our hands, we have found it to be safe. Further work is required to determine whether postoperative use may further reduce the need for blood transfusion.
25例行双侧全膝关节置换术的患者在首次关节置换术结束时给予抑肽酶（100 - 200万单位），剂量根据体重调整。将血液管理情况与我们之前未接受抑肽酶治疗的68例患者系列进行比较。抑肽酶组在前6小时引流并回输的血液（323毫升，标准差320）明显少于未治疗组（1033毫升，标准差539，p<0.0005）。抑肽酶组引流的总血量也较少（713毫升对比1613毫升，p<0.0005），但这完全是由早期失血的差异所致。抑肽酶组使用的其他血液制品较少（360毫升，标准差357对比827毫升，标准差434，p<0.0005）。术后第一天的平均血红蛋白水平相似，约为10克。使用抑肽酶未出现并发症或不良反应。我们得出结论，抑肽酶可显著减少双侧膝关节置换术后的早期失血。在我们的操作中，已发现其是安全的。需要进一步开展工作以确定术后使用是否可进一步减少输血需求。
