Westaby S
Oxford Heart Centre, Radcliffe Hospital, Headington, United Kingdom.
Semin Thorac Cardiovasc Surg. 1997 Jul;9(3):246-56.
Extensive thoracic aortic resections often require a period of profoundly hypothermic circulatory arrest. The extent of surgical dissection, damaging effects of cardiopulmonary bypass, and coagulation disturbances of hypothermia predispose to bleeding. Although impervious vascular grafts and biological glues have made an important contribution to eliminating the vicious cycle of transfusion of stored blood and worsening coagulopathy, hemorrhage remains an important cause of morbidity in these patients. Thrombin generation by activation of the coagulation cascades also leads to excessive fibrinolytic activity with the potential to disrupt the hemostatic process. Pharmacological antifibrinolytic therapy with aprotinin or other agents has been shown to preserve hemostasis, but the efficacy of antifibrinolytic therapy remains unproven in thoracic aortic operations with hypothermic circulatory arrest. This report discusses the interactions of hypothermia with the coagulation system, together with the efficacy of fibrinolytic therapy from existing surgical experience.
广泛的胸主动脉切除术通常需要一段深度低温循环停止期。手术解剖范围、体外循环的损伤作用以及低温引起的凝血紊乱易导致出血。尽管不透水血管移植物和生物胶在消除库存血输注和凝血障碍恶化的恶性循环方面做出了重要贡献，但出血仍然是这些患者发病的重要原因。凝血级联激活产生的凝血酶也会导致过度的纤维蛋白溶解活性，有可能破坏止血过程。使用抑肽酶或其他药物进行药理学抗纤维蛋白溶解治疗已被证明可维持止血，但在低温循环停止的胸主动脉手术中，抗纤维蛋白溶解治疗的疗效仍未得到证实。本报告结合现有手术经验讨论低温与凝血系统的相互作用以及纤维蛋白溶解治疗的疗效。
