小剂量抑肽酶在体外循环中保护血小板作用及减少术后出血

Low dose Aprotinin in Platelet Protection and Postoperative Hemostasis During Cardiopulmonary Bypass

为评估小剂量抑肽酶（１．５×１０６ＫＩＵ）对血小板功能的保护及止血作用，用药组（Ａ组ｎ＝２０）体外循环（ＣＰＢ）预充液中一次性加抑肽酶，对照组（Ｂ组ｎ＝２０）加入同容积生理盐水。检测结果Ａ组较Ｂ组血小板计数、血小板聚集率均增高；血栓烷Ｂ２下降；ＡＣＴ延长但中和效果佳；术中止血时间缩短；术后失血量和输血量明显降低。结论：小剂量抑肽酶减轻血小板膜受体在ＣＰＢ中的损害、增强其聚集功能、减轻血小板数量下降；抑肽酶与肝素有协同作用并竞争性抑制肝素对血小板功能抑制；明显减少手术后失血和输血量。

To evaluate the effect of low dose aprotinin during cardiopulmonary bypass (CPB) on platelet function and hemostasis,40 patients undergoing various CPB procedures were randomized to receive either low dose aprotinin 1.5×10 KIU in the CPB perfusion(20 patients,Group A) or normal saline as placebo(20 patients, Group B).Blood samples were collected before and after CPB till the first postoperative day.The results showed:(1)Intraoperative and postoperative platelet count in group A was mach higher than that in group B( P <0.05).(2)Platelet aggregation induced by ADP and collagen in group A were more marked than that in group B.(3)TXB 2 in group B( P <0.01).(4)ACT was markedlyprolonged in group A as compared with group B during CPB( P <0.01).(5)The average time of hemostasis from the end of CPB to closure of the sternotomy in group A was shorter than that of group B.(6) The total amount of postoperative bleeding and blood reguirement were lower in group B.The authors concluded that low dose aprotinin provides effective protection of the PLT and aggregating function during CPB.It also influences on ACT prolongation and improves postoperative hemostasis and need for transfusion.