Mallett S V, Cox D, Burroughs A K, Rolles K
Department of Anaesthesia, Royal Free Hospital and School of Medicine, Hampstead, London, UK.
Transpl Int. 1991 Dec;4(4):227-30. doi: 10.1007/BF00649108.
Aprotinin has been reported to reduce blood loss in difficult cases requiring cardiopulmonary bypass surgery and more recently in liver transplantation. Over a 9-month period we compared the effects of an intra-operative infusion of aprotinin on transfusion requirements and coagulation profiles in 12 patients undergoing liver transplantation for end-stage cirrhosis with an equal number of consecutive transplants in patients with similar pathology who did not receive aprotinin. Transfusion of blood and blood products was reduced to one-third in the aprotinin-treated group. Operative time was also significantly reduced, as was ICU stay post-operatively. Aprotinin profoundly inhibits fibrinolysis and this is likely to be the major effect by which blood loss is reduced. Thromboelastography revealed severe fibrinolytic changes in the anhepatic stage in 4 of 6 controlled patients; this accelerated in 3 following reperfusion of the new graft. By contrast, only 1 patient of 12 in the aprotinin-treated group showed fibrinolytic activity in the anhepatic period, and none showed evidence of fibrinolysis following reperfusion of the new graft.
据报道，抑肽酶可减少需要进行体外循环手术的复杂病例以及最近肝移植中的失血情况。在9个月的时间里，我们比较了术中输注抑肽酶对12例因终末期肝硬化接受肝移植患者输血需求和凝血指标的影响，并将其与同等数量、病理情况相似但未接受抑肽酶治疗的连续肝移植患者进行了比较。在接受抑肽酶治疗的组中，血液和血液制品的输注量减少到了三分之一。手术时间以及术后在重症监护病房（ICU）的停留时间也显著缩短。抑肽酶能显著抑制纤维蛋白溶解，这可能是其减少失血的主要作用机制。血栓弹力图显示，6例对照患者中有4例在无肝期出现严重的纤维蛋白溶解变化；其中3例在新移植肝脏再灌注后这种变化加速。相比之下，在接受抑肽酶治疗的组中，12例患者仅有1例在无肝期出现纤维蛋白溶解活性，且在新移植肝脏再灌注后均未出现纤维蛋白溶解的迹象。
