D'Errico C C, Shayevitz J R, Martindale S J, Mosca R S, Bove E L
Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, USA.
Anesth Analg. 1996 Dec;83(6):1193-9. doi: 10.1097/00000539-199612000-00011.
We performed a prospective, randomized, placebo-controlled, double-blind trial to assess the efficacy of aprotinin in 61 children (median age 3.7 yr) undergoing reoperative open heart surgery (OHS). Three demographically similar groups were studied: large-dose aprotinin (ALD), small-dose aprotinin (ASD), and placebo (P). Over the first 24 postoperative hours fewer patients in the aprotinin groups received packed red cells (ALD, 53%; ASD, 89%; and P, 95%; P = 0.001), platelets (ALD, 32%; ASD, 50%; and P, 65%; P = 0.04), and fresh frozen plasma (ALD, 16%; ASD, 17%; and P, 60%; P = 0.003) than placebo patients. Most importantly, aprotinin patients had fewer exposures to banked blood components (ALD, median 1 U; and ASD, median 2 U) than P (median 6 U; P = 0.001), with no difference in overall complication rate. Use of aprotinin was associated with a savings in the patient charges for blood components, operating room time, and duration of hospitalization. In conclusion, aprotinin decreased the number of units of banked blood components used during the first 24 postoperative hours in reoperative pediatric OHS. Aprotinin thus decreases the risks associated with exposure to banked blood components and reduces hospital charges.
我们进行了一项前瞻性、随机、安慰剂对照、双盲试验，以评估抑肽酶对61名（中位年龄3.7岁）接受再次心脏直视手术（OHS）儿童的疗效。研究了三组人口统计学特征相似的患者：大剂量抑肽酶组（ALD）、小剂量抑肽酶组（ASD）和安慰剂组（P）。术后头24小时内，与接受安慰剂的患者相比，抑肽酶组接受浓缩红细胞（ALD组为53%，ASD组为89%，P组为95%；P = 0.001）、血小板（ALD组为32%，ASD组为50%，P组为65%；P = 0.04）和新鲜冰冻血浆（ALD组为16%，ASD组为17%，P组为60%；P = 0.003）的患者较少。最重要的是，与P组（中位6单位；P = 0.001）相比，抑肽酶组患者接受库存血液成分的次数较少（ALD组中位1单位，ASD组中位2单位），总体并发症发生率无差异。使用抑肽酶与节省患者在血液成分、手术室时间和住院时间方面的费用相关。总之，抑肽酶减少了小儿再次心脏直视手术后头24小时内使用的库存血液成分单位数。因此，抑肽酶降低了与接触库存血液成分相关的风险并降低了医院费用。
