Pugh S C, Wielogorski A K
Department of Anaesthetics, Brook General Hospital, London.
J Cardiothorac Vasc Anesth. 1995 Jun;9(3):240-4. doi: 10.1016/s1053-0770(05)80314-3.
To assess the relative efficacy of a "low-dose" aprotinin regimen and tranexamic acid on blood loss and homologous blood usage in patients undergoing primary cardiac surgery.
The trial was prospective, randomized, and controlled.
A single center study in a regional cardiothoracic unit in the UK.
75 Patients, age 18 years or over, who were scheduled for routine primary cardiac surgery.
The patients were randomly allocated to receive neither drug nor placebo, a total of 5 g of tranexamic acid, or a total of 2 x 10(6) kallikrein inhibitory units of aprotinin in the perioperative period.
The volume of blood loss and blood replacement were measured in the operative and postoperative periods. Hemoglobin concentration, platelet count, and white cell counts were determined preoperatively and at 24 hours postoperatively. Patients receiving tranexamic acid or aprotinin showed a significant reduction in postoperative blood loss (median[interquartile range] 375 mL [252 to 542] and 230 mL [137 to 547]), respectively, compared with the control group (615 mL [430 to 861]). Blood usage was also reduced in patients in both the tranexamic acid group (600 mL [415 to 800]) and the aprotinin-treated group (420 mL [350 to 887]) compared with the control group (1,050 mL [0 to 1,337]). There was no significant difference in blood loss or homologous blood use between patients treated with tranexamic acid or aprotinin.
Tranexamic acid is as effective as low-dose aprotinin in the reduction of postoperative blood loss and homologous blood transfusion in patients undergoing primary cardiac surgery.
评估“低剂量”抑肽酶方案和氨甲环酸对接受初次心脏手术患者失血及异体血使用的相对疗效。
该试验为前瞻性、随机对照试验。
英国一家地区心胸外科单位的单中心研究。
75例年龄18岁及以上、计划进行常规初次心脏手术的患者。
患者被随机分配在围手术期不接受任何药物或安慰剂、接受总计5 g氨甲环酸或接受总计2×10⁶激肽释放酶抑制单位的抑肽酶。
在手术期和术后测量失血量及输血量。术前及术后24小时测定血红蛋白浓度、血小板计数和白细胞计数。与对照组（615 mL[430至861]）相比，接受氨甲环酸或抑肽酶的患者术后失血量显著减少（中位数[四分位间距]分别为375 mL[252至542]和230 mL[137至547]）。氨甲环酸组（600 mL[415至800]）和抑肽酶治疗组（420 mL[350至887]）的患者输血用量也低于对照组（1050 mL[0至1337]）。接受氨甲环酸或抑肽酶治疗的患者在失血量或异体血使用方面无显著差异。
在减少接受初次心脏手术患者的术后失血和异体输血方面，氨甲环酸与低剂量抑肽酶同样有效。
