摘要
目的 比较抑肽酶和止血芳酸在心肺转流(CPB)中抗纤溶作用及对术后止血量的影响。方法 41例首次择期心脏瓣膜替换术成年患者,随机双盲分为抑肽酶组(A组)20例和试验组(P组)21例。于诱导后、给试验药后5min、CPB 30 min、鱼精蛋白中和10 min和手术后2h,采血测定血浆纤溶酶(Plm)活性,血浆纤维蛋白(原)降解产物(FDP)和卜-二聚体(D-Dimers)浓度,并观察术后48h胸腔及心包引流量。结果 给试验药后5min所有检测指标均无明显变化。Plm在CPB 30min达最高值(P<0.01),中和后10min有所降低,但仍高于基础值(P<0.01),术后2h A组降至基础值水平,P组仍高于基础值(P<0.05),两组相比中和后10 min P组Plm活性明显高于A组(P<0.01),其余各时点均无显著差异。FDP和D-Dimers于CPB 30 min显著增高(P<0.01),中和后10min达到最高值,术后2h A组FDP、D-Dimers和P组的FDP均降至基础值水平,P组D-Dimers仍明显高于基础值(P<0.01)。两组相比CPB 30 min A组D-Dimers含量显著高于P组。两组术后48h内胸液引流量相比无统计学差异。结论 预防性应用抑肽酶或止血芳酸(20mg/kg)可部分抑制CPB中的纤溶亢进;二者的抗纤溶和减少首次手术出血量的作用相近。
Objective To compare the effect of p-aminomethylbenzoic acid(PAMBA) and aprotinin on fibrinolysis and blood loss. Methods 41 valve replacement patients were allocated in a prospective, randomized, double-blind fashion into group A(n = 20) and group P(n=21). The loading dose of aprotinin 3 million KIU infused after induction of anesthesia, 2 million KIU was added into the CPB prime solution. The PAMBA dose was 10 mg/kg infused in 300 ml normal saline after anesthesia induction, 10 mg/kg in 200 ml saline added into the prime solution. Plasma samples for the measurement of plasmin,FDP and D-Dimers were obtained after induction,at 5 min after loading dose,CPB 30 min,after protamine neutralized heparin 10 min and 2 h after operation. Blood loss was determined up to 48 hours. Results The level of plasmin significantly increased in both groups during CPB and after neutralization(P<0. 01), decreased to the baseline at 2 h postoperatively. Plasmin concentration was higher in group A compared to that in group P[(352. 9±103. 4)% vs (218. 2±79. 9)%,P<0. 01] FDP concentration significantly increased in group A at CPB 30 min and after protamine(P<0. 01). In group P,the level of FDP increased after protamine(P<0. 01) ,2 h postoperatively the FDP level was still higher than that of preoperatively,but not significant. The level of D-Dimers increased in group A at CPB 30 min and after protamine 10 min(P<0. 01). In group P,D-Dimers increased at CPB 30 min (P<0. 05), after protamine(P<0. 01) and 2 h postoperatively (P<0. 01). At CPB 30 min, the D-Dimers concentration of group A is significantly higher than that of group P(P<0. 01). No significant difference in blood loss was noted between two groups Cgroup A vs group P (438. 3±213. 0) ml vs (543. 6± 175. 1) ml]. Conclusion Aprotinin or PAMBA can not inhibit fibrinolysis completely during CPB. They have same effect on antifibrinolysis and reducing postoperative blood loss.
出处
《临床麻醉学杂志》
CAS
CSCD
2003年第11期649-651,共3页
Journal of Clinical Anesthesiology
