Lu H, Soria C, Commin P L, Soria J, Piwnica A, Schumann F, Regnier O, Legrand Y, Caen J P
INSERM U 150, Institut des Vaisseaux et du Sang (IVS), Département d'Anesthésiologie, Hôpital Lariboisière, Paris, France.
Thromb Haemost. 1991 Dec 2;66(6):633-7.
The administration of aprotinin during extracorporeal circulation (ECC) reduces blood loss. To explore the mechanism of this effect, a placebo-controlled double-blind study was performed in 20 patients (10 were administered with a high dose of aprotinin, 10 with placebo) undergoing a primary, elective operation of coronary artery bypass grafting (CABG) with ECC. Biological tests were performed at 4 different time points during the operation. A marked reduction in the placebo group of ristocetin-induced platelet agglutination (binding of von Willebrand factor [vWF] to platelet glycoprotein [GP] Ib) was shown during ECC and at the end of surgery, but not in the aprotinin group. This abnormality is not related to the hydrolysis of vWF or GP Ib, since washed platelets were resuspended in pooled normal plasma which provided a constant amount of vWF in this test and since the plasma concentration of the fragment of GP Ib (glycocalicin) did not correlate with this abnormality. Despite a high concentration of heparin (5-7 IU/ml) in patient's plasma during bypass, activation of blood coagulation in both groups was evidenced by an increase in ATm (thrombin-modified antithrombin III) level. The level of ATm in the placebo group reached a maximum at the end of ECC during rewarming, while in the aprotinin group, ATm level at this time point was significantly lower than in the control group. In comparison to the placebo group, the generation of the fibrin degradation products (DDE complexes) was inhibited by aprotinin during ECC, but the level of DDE complexes in the aprotinin group was slightly elevated after ECC, although much less than in the placebo group.(ABSTRACT TRUNCATED AT 250 WORDS)
在体外循环（ECC）期间给予抑肽酶可减少失血。为探究此效应的机制，对20例行初次择期冠状动脉旁路移植术（CABG）并接受ECC的患者进行了一项安慰剂对照双盲研究（10例给予高剂量抑肽酶，10例给予安慰剂）。在手术过程中的4个不同时间点进行生物学检测。结果显示，在ECC期间及手术结束时，安慰剂组中瑞斯托霉素诱导的血小板凝集（血管性血友病因子[vWF]与血小板糖蛋白[GP] Ib结合）显著降低，但抑肽酶组未出现此现象。这种异常与vWF或GP Ib的水解无关，因为洗涤后的血小板重悬于混合正常血浆中，该血浆在本试验中提供了恒定数量的vWF，且GP Ib片段（糖萼素）的血浆浓度与这种异常无关。尽管旁路期间患者血浆中肝素浓度较高（5 - 7 IU/ml），但两组中凝血活化均表现为抗凝血酶Ⅲ（ATm，凝血酶修饰的抗凝血酶Ⅲ）水平升高。安慰剂组中ATm水平在复温时ECC结束时达到最高，而在抑肽酶组，此时的ATm水平显著低于对照组。与安慰剂组相比，抑肽酶在ECC期间抑制了纤维蛋白降解产物（DDE复合物）的生成，但ECC后抑肽酶组中DDE复合物水平略有升高，尽管远低于安慰剂组。（摘要截选至250字）
