Soilleux H, Gillon M C, Mirand A, Daibes M, Leballe F, Ecoffey C
Department of Anesthesiology, Paul Brousse Hospital, Université Paris-Sud, Villejuif, France.
Anesth Analg. 1995 Feb;80(2):349-52. doi: 10.1097/00000539-199502000-00024.
Large prophylactic doses of aprotinin efficiently reduce blood loss during orthotopic liver transplantation (OLT). Small doses of aprotinin are usually used to treat fibrinolysis. However, no studies have investigated the benefit of prophylactic administration of a smaller dose of aprotinin during liver transplantation. We compared two methods of aprotinin therapy on transfusion outcome in liver transplant patients in a prospective study of 199 patients undergoing OLT who were randomized to large or small prophylactic doses of aprotinin during the transplant procedure. In the large-dose group (n = 94) an initial dose of 2,000,000 kallikrein inactivation units (KIU) was followed by infusion of 500,000 KIU/h until the patient's return to the intensive care unit. In the small-dose group (n = 95), an initial dose of 500,000 KIU was followed by an infusion of 150,000 KIU/h. Outcome measurements included intraoperative transfusion requirements (packed red blood cells, fresh frozen plasma, platelets, intraoperative salvage) and postoperative hematologic values. There were no differences in transfusion requirements in the two groups of patients. Patients treated with low-dose aprotinin had slightly higher postoperative fibrinogen concentrations. Large-dose aprotinin therapy does not appear to offer additional benefit compared to low-dose aprotinin administration.
大剂量预防性使用抑肽酶可有效减少原位肝移植（OLT）期间的失血。小剂量抑肽酶通常用于治疗纤维蛋白溶解。然而，尚无研究探讨肝移植期间预防性给予较小剂量抑肽酶的益处。在一项前瞻性研究中，我们比较了两种抑肽酶治疗方法对肝移植患者输血结局的影响，该研究纳入了199例行OLT的患者，他们在移植过程中被随机分为大剂量或小剂量预防性使用抑肽酶组。大剂量组（n = 94）初始剂量为2000000激肽释放酶灭活单位（KIU），随后以500000 KIU/h的速度输注，直至患者返回重症监护病房。小剂量组（n = 95）初始剂量为500000 KIU，随后以150000 KIU/h的速度输注。观察指标包括术中输血需求（红细胞悬液、新鲜冰冻血浆、血小板、术中回收血）和术后血液学指标。两组患者的输血需求无差异。小剂量抑肽酶治疗的患者术后纤维蛋白原浓度略高。与小剂量抑肽酶给药相比，大剂量抑肽酶治疗似乎没有额外益处。
