Lamm Peter, Adelhard Klaus, Juchem Gerd, Weitkunat Rolf, Milz Stefan, Kilger Erich, Götz Alwin, Reichart Bruno
Department of Cardiac Surgery, University of Munich Heart Clinic, Ludwig-Maximilians University of Munich, Wolkerweg 16, 81375 Munich, Germany.
Eur J Cardiothorac Surg. 2007 Oct;32(4):567-72. doi: 10.1016/j.ejcts.2007.07.020. Epub 2007 Aug 29.
Fibrin sealants are frequently used in aortocoronary bypass operations. Although they are considered to be clinically safe, we performed a retrospective analysis of our data to examine the possible side effects of Tissucol fibrin sealant, namely the acute thrombosis of grafts and native coronary arteries resulting in severe myocardial damage and patient deaths.
The data of 2716 patients (2001 male, 715 female) who received an aortocoronary bypass operation from November 1995 to December 1999 were studied retrospectively. Two groups (group 1: received Tissucol, group 2: no sealant used) were compared with respect to an a priori selected set of demographic and clinical variables and with respect to their effect on the outcome using bivariate tabulation. Multiple exploratory assessments of factors possibly related to fatal outcome were done by multiple logistic regression.
Nine hundred ninety patients (group 1) received Tissucol, 1726 patients (group 2) did not receive it. Mean patient age was 64+/-9.1 years. Group 1 had a higher risk of death (7.8% vs 2.8%, p<0.001). The peak values of creatine kinase >500 and creatine kinase-myocardial band >50 were higher in group 1 than in group 2, p<0.001. Adjusted odds ratios for the risk of fatal outcome were: 2.01 for the use of Tissucol, 2.71 for patient age >70 years, 2.02 for aortic cross clamp time >90 min, 3.95 for postoperative ventricular fibrillation, 6.35 for postoperative cardiopulmonary resuscitation, 4.55 for postoperative aortocoronary reoperation.
In our analysis an increased risk of myocardial injury or even death was found in coronary artery bypass grafting patients when Tissucol fibrin sealant was used intraoperatively.
纤维蛋白封闭剂常用于主动脉冠状动脉搭桥手术。尽管它们被认为临床安全，但我们对数据进行了回顾性分析，以研究Tissucol纤维蛋白封闭剂可能的副作用，即移植物和自身冠状动脉的急性血栓形成，导致严重心肌损伤和患者死亡。
回顾性研究1995年11月至1999年12月接受主动脉冠状动脉搭桥手术的2716例患者（2001例男性，715例女性）的数据。比较两组（第1组：接受Tissucol，第2组：未使用封闭剂）在一组预先选定的人口统计学和临床变量方面，以及使用双变量列表法比较它们对结局的影响。通过多因素逻辑回归对可能与致命结局相关的因素进行了多项探索性评估。
990例患者（第1组）接受了Tissucol，1726例患者（第2组）未接受。患者平均年龄为64±9.1岁。第1组的死亡风险更高（7.8%对2.8%，p<0.001）。第1组肌酸激酶>500和肌酸激酶心肌带>50的峰值高于第2组，p<０.001。致命结局风险的调整比值比为：使用Tissucol为2.01，患者年龄>70岁为2.71，主动脉交叉钳夹时间>90分钟为2.02，术后室颤为3.95，术后心肺复苏为6.35，术后主动脉冠状动脉再次手术为4.55。
在我们的分析中，发现冠状动脉搭桥手术患者术中使用Tissucol纤维蛋白封闭剂时，心肌损伤甚至死亡的风险增加。
