Ohuchi H, Okabe H, Nagata N, Kaneko Y
Department of Thoracic Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Nov;44(11):1980-5.
The hemostatic effect of aprotinin in pediatric cardiac surgery is controversial. This study demonstrated the usefulness of aprotinin in cases undergoing additional surgery. In a retrospective study, three groups of children were investigated. In group I (n = 10), no aprotinin or Cell saver was used (control). In group II (n = 12), Cell saver was used intraoperatively. In group III (n = 14), aprotinin 30,000 KIU/kg was added to the prime of cardiopulmonary bypass, and another 10,000 KIU/kg was given every hour during extracorporeal circulation. Both blood loss and use of homologous blood during operation were significantly (p < 0.01) reduced in group III compared to those in the other two groups. In group III, blood loss both 12 and 48 hours postoperatively were one-third less than those in group I (no significant difference). The use of homologous blood 48 hours postoperatively was significantly reduced in group III compared to that in group I (p < 0.01) or group II (p < 0.05). We conclude that aprotinin administration during cardiopulmonary bypass reduced blood loss and homologous blood requirements both operatively and postoperatively when pediatric cardiac surgery must be redone.
抑肽酶在小儿心脏手术中的止血效果存在争议。本研究证明了抑肽酶在接受二次手术的病例中的有效性。在一项回顾性研究中，对三组儿童进行了调查。第一组（n = 10），未使用抑肽酶或血液回收机（对照组）。第二组（n = 12），术中使用血液回收机。第三组（n = 14），在体外循环预充液中加入30000 KIU/kg抑肽酶，并在体外循环期间每小时追加10000 KIU/kg。与其他两组相比，第三组手术期间的失血量和同源血使用量均显著减少（p < 0.01）。在第三组中，术后12小时和48小时的失血量均比第一组少三分之一（无显著差异）。与第一组（p < 0.01）或第二组（p < 0.05）相比，第三组术后48小时同源血的使用量显著减少。我们得出结论，当小儿心脏手术必须再次进行时，体外循环期间给予抑肽酶可减少手术中和术后的失血量及同源血需求量。
