Backer Carl L, Kelle Angela M, Stewart Robert D, Suresh Sunitha C, Ali Farah N, Cohn Richard A, Seshadri Roopa, Mavroudis Constantine
Division of Cardiovascular-Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
J Thorac Cardiovasc Surg. 2007 Dec;134(6):1421-6; discussion 1426-8. doi: 10.1016/j.jtcvs.2007.08.006. Epub 2007 Oct 22.
Aprotinin, a serine protease inhibitor, decreases transfusion requirements and inflammatory response after cardiopulmonary bypass. This study was done to determine whether aprotinin is associated with adverse outcomes, particularly mortality and acute kidney failure, in pediatric patients (<18 years of age) undergoing cardiopulmonary bypass.
We compared a cohort of all pediatric cardiopulmonary bypass operations from 1994-1999, when aprotinin was not used (n = 1230), with a cohort from 2000-2006, when all patients received high-dose aprotinin (n = 1251). Primary end points were operative and late mortality, acute kidney failure, need for dialysis, and neurologic complications. Association of aprotinin with primary end points was assessed by means of univariate analysis, multivariate logistic regression, and Cox regression analysis, where appropriate.
The aprotinin group was younger (mean age, 3.49 +/- 1.84 vs 3.64 +/- 4.75 years; P = .019) and had a higher Aristotle score (7.8 +/- 2.3 vs 7.2 +/- 2.6, P < .001). Univariate and multivariate analysis showed no significant difference between the no-aprotinin and aprotinin groups for operative mortality (55 [4.5%] vs 47 [3.8%], P = .508), acute kidney failure (68 [6.0%] vs 69 [5.7%], P = .77), need for temporary dialysis (6 [0.49%] vs 12 [0.96%], P = .17), or neurologic complications (14 [1.1%] vs 17 [1.4%], P = .62). By means of Cox regression analysis, aprotinin had no influence on late mortality (24 vs 10 deaths, P = .078).
In this retrospective cohort study of pediatric patients undergoing cardiopulmonary bypass, there was no association between the use of aprotinin and acute kidney failure, need for dialysis, neurologic complications, and operative or late mortality. We continue to use aprotinin for all pediatric patients undergoing cardiopulmonary bypass.
抑肽酶是一种丝氨酸蛋白酶抑制剂，可减少体外循环后的输血需求及炎症反应。本研究旨在确定抑肽酶与接受体外循环的儿科患者（＜18岁）的不良结局，尤其是死亡率和急性肾衰竭是否相关。
我们将1994年至1999年未使用抑肽酶的所有儿科体外循环手术队列（n = 1230）与2000年至2006年所有患者均接受高剂量抑肽酶的队列（n = 1251）进行比较。主要终点为手术及晚期死亡率、急性肾衰竭、透析需求和神经系统并发症。抑肽酶与主要终点的相关性通过单因素分析、多因素逻辑回归分析以及适当情况下的Cox回归分析进行评估。
抑肽酶组患者年龄更小（平均年龄3.49±1.84岁 vs 3.64±4.75岁；P = 0.019），且亚里士多德评分更高（7.8±2.3 vs 7.2±2.6，P＜0.001）。单因素和多因素分析显示，未使用抑肽酶组与抑肽酶组在手术死亡率（55例[4.5%] vs 47例[3.8%]，P = 0.508）、急性肾衰竭（68例[6.0%] vs 69例[5.7%]，P = 0.77）、临时透析需求（6例[0.49%] vs 12例[0.96%]，P = 0.17）或神经系统并发症（14例[1.1%] vs 17例[1.4%]，P = 0.62）方面无显著差异。通过Cox回归分析，抑肽酶对晚期死亡率无影响（24例死亡 vs 10例死亡，P = 0.078）。
在这项针对接受体外循环的儿科患者的回顾性队列研究中，抑肽酶的使用与急性肾衰竭、透析需求、神经系统并发症以及手术或晚期死亡率之间无相关性。我们继续对所有接受体外循环的儿科患者使用抑肽酶。
