Urban A E, Popov-Cenić S, Noë G, Kulzer R
Clin Ther. 1984;6(4):425-33.
The purpose of this study was to evaluate a new approach to managing thrombohemorrhagic diathesis in infants and children undergoing extracorporeal circulation during open-heart surgery. Treatment consisted of administering vitamin K1 and aprotinin preoperatively as well as during bypass and after neutralization of heparin. Operative techniques were either surface-induced deep hypothermia and total circulating arrest or conventional bypass with mild-to-moderate hypothermia. At completion of the intracardiac repair, heparin was neutralized with protamine chloride (1:0.7-0.8). Complete bleeding and clotting studies were carried out in 122 patients before, during, and after the bypass procedure. Most of the infants, especially those with congenital cyanotic heart disease, had marked fibrinolysis and vitamin K1 deficiency preoperatively. All patients postoperatively exhibited fibrinolysis and proteolysis greatly exceeding normal values with increased bleeding tendency. The treatment significantly reduced blood loss and transfusion requirements.
本研究的目的是评估一种新的方法，用于管理在心脏直视手术中接受体外循环的婴幼儿和儿童的血栓出血素质。治疗方法包括在术前、体外循环期间以及肝素中和后给予维生素K1和抑肽酶。手术技术采用体表诱导深度低温和完全循环停止或常规体外循环并伴有轻至中度低温。在心内修复完成后，用鱼精蛋白氯化物（1:0.7 - 0.8）中和肝素。在122例患者体外循环手术前、手术期间和手术后进行了完整的出血和凝血研究。大多数婴儿，尤其是患有先天性青紫型心脏病的婴儿，术前有明显的纤维蛋白溶解和维生素K1缺乏。所有患者术后均表现出纤维蛋白溶解和蛋白水解大大超过正常值，出血倾向增加。该治疗方法显著减少了失血量和输血需求。
