Regragui I A, Bryan A J, Izzat M B, Wisheart J D, Hutter J A, Angelini G D
Department of Cardiac Surgery, University of Bristol, United Kingdom.
J Heart Valve Dis. 1995 Nov;4(6):674-7.
Aprotinin is widely used during high risk cardiac surgery to reduce blood loss. Concern has been expressed about the safety of aprotinin in association with hypothermic circulatory arrest for surgery of the thoracic aorta and aortic valve.
A consecutive series of 19 patients undergoing surgery of the ascending aorta and/or the aortic arch using hypothermic circulatory arrest (15 - 20 degrees C) in conjunction with the use of aprotinin were studied prospectively from January 1993 to October 1994. The indications for operation were aortic dissection (n = 15) (11 acute) or annuloaortic ectasia (n = 4); 11 were emergency procedures. Ten patients underwent aortic valve replacement as part of a composite aortic root replacement and in seven patients aortic valve resuspension was possible.
Mean total chest tube drainage was 878 +/- 548 ml (range 300 - 2,000 ml) with a mean usage of homologous blood of 2,328 +/- 1,600 ml. All but one patient survived (mortality 5.3%). None of the survivors experienced any adverse cardiac or neurological events. Serum creatinine rose significantly from a mean of 102 +/- 17 micromol/L preoperatively, to a mean of 172 +/- 100 micromol/L postoperatively (p<0.05), however, none of the patients became anuric or required dialysis and all values returned to preoperative levels by six weeks after surgery. Median intensive care stay was two days (range 1 - 20 days) and the median postoperative hospital stay was 11 days (range 6 - 50 days).
These data suggest that aprotinin in conjunction with hypothermic circulatory arrest for surgery of the thoracic aorta and aortic valve has no adverse effect on early survival. However, significant though transient postoperative renal dysfunction was commonly observed in our experience.
抑肽酶在高危心脏手术中被广泛用于减少失血。对于在胸主动脉和主动脉瓣手术中使用抑肽酶联合低温循环停搏的安全性已有人表示担忧。
对1993年1月至1994年10月期间连续纳入的19例行升主动脉和/或主动脉弓手术并使用低温循环停搏（15 - 20摄氏度）及抑肽酶的患者进行前瞻性研究。手术适应证为主动脉夹层（n = 15）（11例为急性）或主动脉瓣环扩张（n = 4）；11例为急诊手术。10例患者在复合主动脉根部置换术中进行了主动脉瓣置换，7例患者可行主动脉瓣再悬吊术。
平均胸管总引流量为878±548 ml（范围300 - 2000 ml），平均同源血用量为2328±1600 ml。除1例患者外均存活（死亡率5.3%）。所有存活者均未发生任何不良心脏或神经事件。血清肌酐从术前平均102±17 μmol/L显著升至术后平均172±100 μmol/L（p<0.05），然而，无患者出现无尿或需要透析，且所有值在术后6周时均恢复至术前水平。重症监护平均住院时间为2天（范围1 - 20天），术后平均住院时间为11天（范围6 - 50天）。
这些数据表明，抑肽酶联合低温循环停搏用于胸主动脉和主动脉瓣手术对早期生存无不良影响。然而，根据我们的经验，术后常见显著但短暂的肾功能障碍。
