Huth C, Seybold-Epting W, Hoffmeister H E
Thorac Cardiovasc Surg. 1983 Jun;31(3):142-6. doi: 10.1055/s-2007-1021964.
In the last year fibrin glue Tissucol was used for local hemostasis in 21 patients subjected to correction of tetralogy of Fallot (ToF) and in 10 patients subjected to Senning-procedure in transposition of the great arteries (TGA). The postoperative blood loss was compared with the blood loss of 20 ToF-patients and 10 TGA-patients who had undergone correction one year ago without fibrin glue. Between the 2 groups were no differences in age, sex, bodyweight (BW), coagulation state or operative management. Two hours postoperatively the blood loss with fibrin glue was 2.2 ml/hr/kg BW in ToF-patients and 2.4 ml/hr/kg BW in TGA-patients, whereas without fibrin glue it was 4.2 ml/hr/kg BW in ToF (p less than 0.01) and 4.5 ml/hr/kg BW in TGA (p less than 0.01). The same significant difference (p less than 0.01) was found 6 hours postoperatively with 1.4 versus 2.2 ml/hr/kg BW in ToF and 1.9 versus 2.5 ml/hr/kg BW in TGA. Over the following 18 hours the secretion from the chest tubes was identical in both groups. Six patients with ToF and one patient with TGA required reoperation for bleeding. The blood loss per kg BW per hour at reoperation was 6.9 ml with and 8.2 ml without fibrin glue (N.S.). The blood loss of patients who did not require reoperation at the same time was 4.6 times lower with fibrin glue and only 3.7 times lower without fibrin glue. Fibrin glue reduces blood loss after intracardiac repair of ToF and TGA by local hemostasis at patches and suture lines. The application of fibrin glue can facilitate differentiation of surgical bleedings and the indication for reoperations.
在过去一年中，纤维蛋白胶Tissucol用于21例接受法洛四联症（ToF）矫正手术的患者以及10例接受大动脉转位（TGA）Senning手术的患者的局部止血。将术后失血量与一年前未使用纤维蛋白胶而接受矫正手术的20例ToF患者和10例TGA患者的失血量进行比较。两组患者在年龄、性别、体重（BW）、凝血状态或手术管理方面无差异。术后两小时，使用纤维蛋白胶的ToF患者失血量为2.2毫升/小时/千克体重，TGA患者为2.4毫升/小时/千克体重；而未使用纤维蛋白胶时，ToF患者为4.2毫升/小时/千克体重（p<0.01），TGA患者为4.5毫升/小时/千克体重（P<0.01）。术后6小时也发现了同样显著的差异（p<0.01），ToF患者分别为1.4和2.2毫升/小时/千克体重，TGA患者分别为1.9和2.5毫升/小时/千克体重。在接下来的18小时内，两组胸腔引流管的引流量相同。6例ToF患者和1例TGA患者因出血需要再次手术。再次手术时每千克体重每小时的失血量，使用纤维蛋白胶的为6.9毫升，未使用的为8.2毫升（无统计学意义）。同期无需再次手术的患者，使用纤维蛋白胶时失血量降低了4.6倍，未使用时仅降低了3.7倍。纤维蛋白胶通过在补片和缝线处局部止血，减少ToF和TGA心脏内修复术后的失血量。纤维蛋白胶的应用有助于区分手术出血情况及再次手术的指征。
