Baufreton C, Velthuis H T, Jansen P G, Besnerais P L, Wildevuur C H, Loisance D Y
Department of Thoracic and Cardiovascular Surgery, Association Claude Bernard, Hôpital Henri Mondor, Créteil, France.
ASAIO J. 1996 Sep-Oct;42(5):M417-23. doi: 10.1097/00002480-199609000-00023.
Aprotinin reduces blood loss after cardiac surgery, particularly in patients taking aspirin. This study was performed to evaluate whether the reduction of contact phase activation by aprotinin is related to decreased complement activation during blood activation. Two hundred patients were prospectively operated on for coronary artery bypass. Aprotinin was used in the cardiopulmonary bypass (CPB) prime if aspirin was not discontinued 10 days before surgery and in patients undergoing second operation (n = 102). Blood loss was significantly reduced in patients receiving aprotinin (596 +/- 309 ml vs 754 +/- 329 ml without aprotinin; p = 0.0001), as was the need for transfusion (13% vs 34% without aprotinin; p = 0.0001) after surgery. Blood activation has been studied in 60 patients. Multivariate analysis showed that contact phase activation, as assessed by maximum values of C1 inhibitor/kallikrein complexes, was reduced by aprotinin treatment (p < 0.0001). Fibrinolytic activity decreased with aprotinin treatment, as reflected by lower values of D-dimers at the end of CPB (p < 0.0001). In addition, thrombin generation, as assessed by F1 + 2 scission peptide, was reduced by aprotinin (p = 0.01). However, the stepwise regression model emphasized that activation of the alternative and classic complement pathways, as reflected by C3b/c and C4b/c levels, was not affected by aprotinin; neither was leukocyte activation, as reflected by elastase release. These results suggest that aprotinin does not combine the reduction of complement activation with the reduced activation of the contact phase, fibrinolysis, or coagulation during CPB for coronary artery surgery.
抑肽酶可减少心脏手术后的失血，尤其是在服用阿司匹林的患者中。本研究旨在评估抑肽酶减少接触相激活是否与血液激活过程中补体激活减少有关。200例患者前瞻性地接受冠状动脉搭桥手术。如果术前10天未停用阿司匹林以及在接受二次手术的患者（n = 102）中，抑肽酶被用于体外循环（CPB）预充液中。接受抑肽酶治疗的患者失血明显减少（596±309 ml对比未使用抑肽酶的754±329 ml；p = 0.0001），术后输血需求也明显减少（13%对比未使用抑肽酶的34%；p = 0.0001）。对60例患者的血液激活情况进行了研究。多变量分析显示，通过C1抑制剂/激肽释放酶复合物的最大值评估，抑肽酶治疗可降低接触相激活（p < 0.0001）。CPB结束时D - 二聚体值较低，表明抑肽酶治疗可降低纤溶活性（p < 0.0001）。此外，通过F1 + 2裂解肽评估，抑肽酶可减少凝血酶生成（p = 0.01）。然而，逐步回归模型强调，替代和经典补体途径的激活，通过C3b/c和C4b/c水平反映，不受抑肽酶影响；弹性蛋白酶释放反映的白细胞激活也不受影响。这些结果表明，在冠状动脉手术的CPB期间，抑肽酶并未将补体激活的减少与接触相、纤溶或凝血的激活减少相结合。
