Liu Y C, Tsai T P
Department of Anesthesiology, China Medical College Hospital, Taichung, Taiwan, R.O.C.
Acta Anaesthesiol Sin. 1998 Sep;36(3):149-54.
Bleeding remains a major complication and a major determinant in the prognosis of open-heart surgery. Coagulopathy related to cardiopulmonary bypass (CPB) seems to be the culprit. Since homologous blood transfusion in many occasions is not only responsible for mobidity and mortality but also increases medical costs. Therefore, the application of autologous blood transfusion including components such as PRBC, FFP and platelets concentrate is inevitable and comes in its stead. To reduce the use of homologous plasma and platelets transfusion in open-heart surgery, we designed a study to utilize the combination of autologous platelet rich plasma (PRP) and epsilon aminocaproic acid (EACA) to evaluate its effects on blood loss and blood component transfusion in open-heart patients.
Sixty patients who received elective cardiac surgery were randomly divided into 3 groups: 1. Control group; 2. EACA group (150 mg/kg, i.v. before CPB); 3. PRP-EACA group (PRP 10 ml/kg harvested with a plasma saver followed by i.v. EACA 150 mg/kg). Anesthesia was uniform in all patients. Coagulation profile was evaluated by thromboelastography (TEG) during the operation. Blood loss during operation and the amount of drainage from the chest tubes in the postoperative period were recorded and compared between groups.
Patients who were given EACA injection before CPB saw less blood loss perioperatively and received less transfusion of blood components. TEG analysis showed that patients who received EACA injection had a better coagulation profile and the platelet function was also better after CPB. However, no additive effect can be attained from combination of autologous PRP transfusion and EACA injection.
With Pre-CPB EACA as protection, reduction of both blood loss and blood transfusion could be realized in open-heart surgery.
出血仍然是心脏直视手术的主要并发症和预后的主要决定因素。与体外循环（CPB）相关的凝血病似乎是罪魁祸首。由于在许多情况下，同种异体输血不仅会导致发病率和死亡率，还会增加医疗成本。因此，包括浓缩红细胞、新鲜冰冻血浆和血小板等成分的自体输血的应用不可避免且取而代之。为减少心脏直视手术中同种异体血浆和血小板输血的使用，我们设计了一项研究，利用自体富血小板血浆（PRP）和氨甲环酸（EACA）的组合来评估其对心脏直视手术患者失血和血液成分输血的影响。
60例接受择期心脏手术的患者被随机分为3组：1. 对照组；2. EACA组（150mg/kg，CPB前静脉注射）；3. PRP-EACA组（用血浆回收器采集10ml/kg的PRP，随后静脉注射150mg/kg的EACA）。所有患者麻醉方式相同。术中通过血栓弹力图（TEG）评估凝血情况。记录并比较各组手术期间的失血量和术后胸腔引流管的引流量。
在CPB前注射EACA的患者围手术期失血量较少，接受的血液成分输血也较少。TEG分析显示，接受EACA注射的患者凝血情况较好，CPB后血小板功能也较好。然而，自体PRP输血和EACA注射联合使用并未产生叠加效应。
以CPB前EACA作为保护措施，可在心脏直视手术中实现减少失血和输血。
