Tatar H, Ciçek S, Demirkiliç U, Ozal E, Süer H, Oztürk O, Işiklar H
Department of Cardiovascular Surgery, GATA, Gulhane School of Medicine, Ankara, Turkey.
Ann Thorac Surg. 1993 Mar;55(3):659-61. doi: 10.1016/0003-4975(93)90271-i.
Among various pharmacological agents used to reduce bleeding after open-heart operations, high-dose aprotinin therapy seems most promising. However, its long-term effects are still obscure; there is almost always possibility of bypass graft occlusions produced by the hypercoagulable state induced by aprotinin in coronary bypass operations. Topical application of aprotinin into the pericardial cavity could prevent the adverse effects. Fifty patients were prospectively studied to evaluate the effects of topical aprotinin. One million KIU of aprotinin was poured into the pericardial cavity before closure of the sternotomy in group 1 (n = 25). Patients in group 2 (n = 25) served as controls. Total postoperative bleeding was significantly reduced in group 1 when compared with that of group 2 (722.7 +/- 230.8 versus 1,282.6 +/- 225.7 mL; p < 0.01). The use of banked donor blood products was significantly less in group 1 than in group 2 (0.33 +/- 0.67 versus 1.36 +/- 0.86 units; p < 0.01). These results show that topical use of aprotinin reduces post-operative blood loss and need for transfusion. It seems promising and warrants further studies to be done.
在用于减少心脏直视手术后出血的各种药物中，高剂量抑肽酶疗法似乎最有前景。然而，其长期效果仍不明确；在冠状动脉搭桥手术中，抑肽酶诱导的高凝状态几乎总会导致旁路移植血管闭塞。将抑肽酶局部应用于心包腔可预防不良反应。对50例患者进行前瞻性研究以评估局部应用抑肽酶的效果。第1组（n = 25）在胸骨切开术关闭前将100万KIU抑肽酶注入心包腔。第2组（n = 25）患者作为对照。与第2组相比，第1组术后总出血量显著减少（722.7±230.8对1282.6±225.7 mL；p < 0.01）。第1组库存供血制品的使用量显著少于第2组（0.33±0.67对1.36±0.86单位；p < 0.01）。这些结果表明，局部应用抑肽酶可减少术后失血量和输血需求。它似乎很有前景，值得进一步研究。
