体外循环时小剂量抑肽酶对纤溶系统和血小板的影响

Effect of Low-dose Aprotinin of Fibrinolytic System and Platelet during Cardiopulmonay Bypass

心脏直视手术体外循环时应用小剂量抑肽酶，观察其对纤溶系统和血小板的影响。３０例随机分为对照组和抑肽酶用药组。用药组仅一次在预充液中加入小剂量抑肽酶２×１０６ＫＩＵ。分别于转流前、转流３０分钟、转流结束时及转流停止后２小时测定ＰＬＧ、ＦＤＰ、ＰＫ、ＴＸＢ２、ｔ－ＰＡ、６－ｋｅｔｏ－ＰＧＦ１α，ＴＸＢ２／６－ｋｅｔｏ－ＰＧＦ１α浓度。术后２４小时纵隔心包引流量用药组较对照组减少出血４１．７％，Ｐ＜０．０１。电镜观察用药组血小板改变不明显；对照组呈现破碎、脱颗粒、微管扩张、聚集。作者认为小剂量抑肽酶能有效地抑制高纤溶活性，可保护血小板功能，减少术后出血。

This article is to study the effect of low-dose aprotinin on postoperative blood loss in patients undergoing cardiopulmonary bypass(CPB)for cardiac operations and to elucidate the mechanism of aprotinin action。Clinical materials and methods:30 patients were ran domly divided into the control group and the aprotinin group.In the aprotinin group,2×106 KIU aprotinin was added to the priming solution of the CPB.PLG,FDP,PK,TXB2,t-PA,6-keto-PGF1α,TXB2/6-keto-PGF1αwere determined before CPB,at thirty minutes of CPB,at end of CPB,2 hours after CPB respectively,Results:During the first 24 hour,postoperative blood loss was reduced 4l.7%in the aprotinin group as compared with that in the control group(526±137 ml versus 896±288 ml,P<0.01).During CPB,disruption and aggregation of the platelet,and degranulation and dilatation of the microtubeles inside of the platelets were observed under electron microscope in the control group but there was no distinct changes of the platelets in the aprotinin group.Conclusion:These findings indicated that low-dose aprotinin administration was effective in reducing postoperative blood loss。The improved hemostasis is mainly attibutable to inhibition of hyperfibrinolysis and preserved the integrity of the platelet during CPB.