抑肽酶对脑外科手术患者的血液保护作用

The effect of aprotinin for hemostasis during intracranial surgery

目的观察不同剂量抑肽酶对脑外科手术患者的血液保护作用。方法选择63例颅脑外科手术患者,采用随机双盲法将其分为三组,小剂量抑肽酶组(A组):手术开始前给予0.5×106kU预给量,而后持续泵入5×105kU/h直至手术结束;大剂量抑肽酶组(B组):手术开始前给予2×106kU预给量,而后持续泵入5×105kU/h直至手术结束;对照组(C组)则给予维生素K120mg。观察手术失血量;术后24h引流量;术中及术后3d输血量;术前、术毕、术后24hHb、HCT、血小板(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血浆纤维蛋白原含量(FIB)。结果A组术毕、术后24hHb分别为(101.80±10.95)g/L和(109.45±11.14)g/L;B组分别为(98.75±6.08)g/L和(104.55±5.23)g/L;C组为(90.30±6.66)g/L及(98.40±7.34)g/L。A组术毕和术后24h的HCT分别为(0.32±0.03)和(0.34±0.03);B组为(0.31±0.03)和(0.33±0.02);C组为(0.27±0.04)和(0.31±0.02)。A、B两组间无显著性差异,但与C组比较P均<0.05。凝血功能的检查中,各时间点上三组的FIB、PT之间无显著性差异,而A、B两组的APTT显著延长,术毕A组为(26.15±1.35)s,B组为(26.40±1.93)s,C组为(24.40±1.43)s,C组与A、B组比较P<0.05;术后24hA组APTT为(30.05±1.47)s,B组为(32.45±2.24),C组为(22.45±1.67)s,A、B组比较P<0.01,C组与A、B组比较P<0.05。PLT在术后24h时间点A、B两组较C组的值高(P<0.05)。结论抑肽酶可明显减少围术期出血及异体输血,APTT显著延长,其他检查小剂量组与大剂量组无显著性差异,因此小剂量抑肽酶与大剂量抑肽酶同样有效,且更安全、经济。

Objectives To evaluate the prophylactic effect of intravenous aprotinin in reducing intraoperative blood loss in the neurosurgical population. Methods A randomized, double-blind, placebo-controlled trial was conducted in three groups. Sixty-three patients （ASA1-3）with a preoperative diagnosis of cereal disease were included. The first group was administered 50 000 kailikrein-inhibiting units （kU） for induction of anesthesia and was then continued with an infusion of 500 000 kU/hr until the surgery was completed, the second group used 200 000 kU for induction, infusion of 500 000 kU/hr for maintence, the last group were inducted with vitK1 20 mg. Intraoperative blood loss, volume of blood transfusion, HB,PLT,HCT.APTT,FIB,PT were measured. Results There was no statistical difference in the pre-operative parameters between the 3 groups. The volume of blood loss during the operation, volume of drainage within 24 hours after operation and the volume of blood transfusion were less in group A and B than group C （P〈0.05）, so there were corresponding changes in HB.HCT levels in 3 groups, However, there was no statistical difference between group A and B. There was no statistical difference in 3 groups at all time points in hemostatic tests. The APTT in group A and B was markedly prolanged and there was difference within 24 hours after operation （P〈0.05）. The platelet count was higher in group A and B than group C within 24 hours after operation（P〈0.05） but there was no difference between group A and B. Conclusions Intraoporative blood loss is reduced. There is no significant difference in postoperative thrombotic risk or other outcome measures, but APTT was obviously delayed. Aprotinin therefore can be safely used to reduce intraoperative blood loss in patients who are not receiving anticoagulation therapy and there is no difference between treatment groups.