Penta de Peppo A, Pierri M D, Scafuri A, De Paulis R, Colantuono G, Caprara E, Tomai F, Chiariello L
University of Rome Tor Vergata, Department of Cardiac Surgery, European Hospital, Italy.
Tex Heart Inst J. 1995;22(3):231-6.
Sixty consecutive patients undergoing elective open-heart surgery were prospectively enrolled in a study to compare the efficacy of 3 different antifibrinolytic drugs to reduce postoperative bleeding and to reduce homologous blood requirements in combination with blood-saving techniques and restrictive indications for blood transfusion. The patients were randomized to 1 of 4 intraoperative treatment regimens: 1) control (no antifibrinolytic therapy); 2) epsilon-aminocaproic acid (10 g IV at induction of anesthesia, followed by infusion of 2 g/h for 5 hours); 3) tranexamic acid (10 mg/kg IV within 30 minutes after induction of anesthesia, followed by infusion of 1 mg/kg per hour for 10 hours); or 4) high-dose aprotinin (2 million KIU IV at induction of anesthesia and 2 million KIU added to the extracorporeal circuit, followed by infusion of 500 thousand KIU/h during surgery). Hemoconcentration and reinfusion of blood drained from the operative field and the extracorporeal circuit after operation were used in all patients. Indications for blood transfusion were hypotension, tachycardia, or both, with hemoglobin values < 8.5 g/dL; or severe anemia with hemoglobin values < 7 g/dL. Compared with the blood loss in the control group, patients receiving aprotinin and epsilon-aminocaproic acid showed significantly less postoperative blood loss at 1 hour (control, 128 +/- 94 mL; aprotinin, 54 +/- 47 mL, p = 0.01; and epsilon-aminocaproic acid, 69 +/- 35 mL, p = 0.03); this trend continued at 24 hours after operation (control, 724 +/- 280 mL; aprotinin, 344 +/- 106 mL, p < 0.0001; and epsilon-aminocaproic acid, 509 +/- 148 mL, p = 0.01). Aprotinin was significantly more efficient than epsilon-aminocaproic acid (p=0.002). Tranexamic acid did not have a statistically significant effect on blood loss. Homologous blood requirements were not significantly different among the groups; postoperative hematologic values and coagulation times were also comparable. Despite the efficacy of aprotinin and epsilon-aminocaproic acid shown in the present study, the blood requirements were not significantly different from those that are found when transfusions are restricted, autotransfusions are used, and blood from the operative field and extracorporeal circuit is concentrated and reinfused. Therefore, intraoperative antifibrinolysis may not be indicated in routine cardiac surgery when other blood-saving techniques are adopted.
连续60例接受择期心脏直视手术的患者被前瞻性纳入一项研究，以比较3种不同抗纤溶药物与血液保护技术及严格输血指征联合使用时减少术后出血和减少同源血需求的疗效。患者被随机分为4种术中治疗方案中的1种：1）对照组（不进行抗纤溶治疗）；2）ε-氨基己酸（麻醉诱导时静脉注射10 g，随后以2 g/h的速度输注5小时）；3）氨甲环酸（麻醉诱导后30分钟内静脉注射10 mg/kg，随后以1 mg/kg每小时的速度输注10小时）；或4）高剂量抑肽酶（麻醉诱导时静脉注射200万KIU，体外循环中再添加200万KIU，随后手术期间以50万KIU/h的速度输注）。所有患者均采用血液浓缩及术后回输手术野和体外循环引流血的方法。输血指征为低血压、心动过速或两者兼有且血红蛋白值<8.5 g/dL；或严重贫血且血红蛋白值<7 g/dL。与对照组的失血量相比，接受抑肽酶和ε-氨基己酸治疗的患者术后1小时的失血量明显减少（对照组，128±94 mL；抑肽酶组，54±47 mL，p = 0.01；ε-氨基己酸组，69±35 mL，p = 0.03）；术后24小时这种趋势仍持续（对照组，724±280 mL；抑肽酶组，344±106 mL，p<0.0001；ε-氨基己酸组，509±148 mL，p = 0.01）。抑肽酶比ε-氨基己酸明显更有效（p = 0.
