抑肽酶与氨甲环酸对心脏手术失血影响的比较

[Comparison of effects of aprotinin and tranexamic acid on blood loss in heart surgery].

作者信息

Corbeau J J, Monrigal J P, Jacob J P, Cottineau C, Moreau X, Bukowski J G, Subayi J B, Delhumeau A

机构信息

Département d'Anesthésie-Réanimation, CHU, Angers.

出版信息

Ann Fr Anesth Reanim. 1995;14(2):154-61.

PMID:7486272

Abstract

OBJECTIVES

To compare the efficacy of aprotinin (APR) and tranexamic acid (TRA) in reducing blood loss and transfusion requirements after cardiac surgery under extracorporeal circulation (ECC).

STUDY DESIGN

Randomized controlled trial.

PATIENTS

One hundred and four adults undergoing either coronary artery bypass grafting (CABG) (n = 55), or aortic valve replacement (AVR) (n = 49), allocated into three groups.

METHODS

a) APR group (23 CABG and 20 AVR) received aprotinin, 2 x 10(6) KIU (280 mg) after induction, followed by an infusion of 0.5 x 106 KIU.h-1 (70 mg.h-1) until chest closure, with a supplement to the oxygenator prime of 2 x 10(6) KIU; b) TRA group (22 CABG and 19 AVR) received tranexamic acid, 15 mg.kg-1 between the injection of heparin (400 IU.kg-1) and the beginning of ECC, 15 mg.kg-1 after protamin injection (1.3 mg/100 IU of heparin); c) CTR group (10 CABG and 10 AVR), the control group, was not treated with an antifibrinolytic agent. The amount of blood collected from the chest tube drainage was measured at admission to ICU, as well as 4, 8 and 18 h after the insertion of drains and at the time of their removal. Packed red cells where given when the haematocrit was under 20% during ECC, 25% at the end of surgery and 30% after extubation.

RESULTS

The blood loss was lower in APR group (834 +/- 448 mL) than in TRA group (1015 +/- 409 mL) (P = 0.009), and in CTR group (1416 +/- 559 ML) (P = 0.004). The rates of transfused patients in groups APR, ATR and CTR were 35, 37 and 60% respectively and the numbers of units administered per patient were 0.8, 0.8 and 1.7 respectively. In AVR cases, APR and TRA had a similar efficacy. In CABG cases, only aprotinin decreased postoperative bleeding. However there was no difference between APR and TRA concerning the transfusion requirements. In CABG cases the ECC was of shorter duration and blood loss was 1127 +/- 540 mL vs 894 +/- 422 mL in AVR cases (P = 0.03).

CONCLUSIONS

Both APR and TRA decrease blood loss. APR is more efficient after CABG than TRA as far as blood loss is concerned, whereas the transfusion requirements are similar. As APR is about 100 times more expensive and carries a risk for allergic reactions, its use in a high dose regimen is only recommended for reoperations, in patients treated with salicylates and in case of sepsis.

摘要

目的

比较抑肽酶（APR）和氨甲环酸（TRA）在减少体外循环（ECC）心脏手术后失血及输血需求方面的疗效。

研究设计

随机对照试验。

患者

104例成年患者，接受冠状动脉搭桥术（CABG）（n = 55）或主动脉瓣置换术（AVR）（n = 49），分为三组。

方法

a）APR组（23例CABG和20例AVR）诱导后给予抑肽酶2×10⁶KIU（280mg），随后以0.5×10⁶KIU·h⁻¹（70mg·h⁻¹）持续输注直至关胸，并在氧合器预充液中补充2×10⁶KIU；b）TRA组（22例CABG和19例AVR）在注射肝素（400IU·kg⁻¹）至ECC开始期间给予氨甲环酸15mg·kg⁻¹，鱼精蛋白注射后（1.3mg/100IU肝素）再给予15mg·kg⁻¹；c）CTR组（10例CABG和10例AVR），即对照组，未接受抗纤溶药物治疗。在入住重症监护病房（ICU）时、放置引流管后4、8和18小时以及拔除引流管时测量胸腔引流管引流出的血量。当体外循环期间血细胞比容低于20%、手术结束时低于25%以及拔管后低于30%时输注浓缩红细胞。

结果

APR组（834±448mL）的失血量低于TRA组（1015±409mL）（P = 0.009），也低于CTR组（1416±559mL）（P = 0.004）。APR组、ATR组和CTR组的输血患者比例分别为35%、37%和60%，每位患者输注的单位数分别为0.8、0.8和1.7。在AVR病例中，APR和TRA疗效相似。在CABG病例中，只有抑肽酶可减少术后出血。然而，APR和TRA在输血需求方面无差异。在CABG病例中，ECC持续时间较短，失血量为1127±540mL，而AVR病例中为894±422mL（P = 0.03）。