抑肽酶对心脏不停跳心内直视手术血小板活化因子的影响

Effects of aprotinin on platelet activating factor underwent beating Open-heart Surgery with cardiopulmonary bypass

目的观察心脏不停跳心内直视手术围术期应用大剂量抑肽酶对患者血液中血小板活化因子 (PAF)的影响和患者住院期间的输血量、术后引流量的关系。方法 36例体外循环 (CPB)心内直视手术的患者随机分为两组 :实验组 ,n =18,术中应用大剂量抑肽酶 ;对照组 ,n =18,术中不应用抑肽酶 ,动态监测围术期血液中PAF的水平变化 ,并记录患者住院期间的输血量和术后总的引流量。结果实验组PAF水平从转流 2 0min到术后 2 4小时均明显低于对照组 ,(P <0 0 5或P <0 0 1) ,且从转流 2 0min到术后 8小时明显高于术前 (P <0 0 5或P <0 0 1) ,对照组从转流 2 0min到术后 2 4小时均明显高于术前 (P <0 0 5或P <0 0 1) ;实验组患者住院期间输血量和术后引流量明显少于对照组 (P <0 0 1)。结论心脏不停跳心内直视手术 ,由于其术中的高灌注流量和较高的体外循环温度 ,可使机体生成PAF增加 ,从而激活血小板 ,导致术后凝血功能紊乱。抑肽酶有抑制机体产生PAF的作用 ,可有效的保护血小板的功能 ,减轻患者术后的全身系统性炎性反应 。

Objective To investigate the effects of aprotinin on platelet activating factor(PAF) underwent beating open-heart operation with cardiopulmonary bypass(CPB). Methods 36 cases of open-heart operation patients were divided into test group and control group( n =18), the parameters of PAF were measured during the perioperative period; the blood transfusion and the postoperative chest tube drainage were recorded during hospitalization. Results The changes of the PAF in test group were significantly lower from CPB 20 minutes to 24 hours of postoperation than those in control group ( P <0.05 or P <0.01); it was significantly higher from 20 minutes CPB to 8 hours of postoperation in test group than those before operation ( P <0.05 or P <0.01) and it was significantly higher from 20 minutes CPB to 24 hours postoperation in control group the those before operation ( P <0.05 or P <0.01); the blood transfusion during hospitalization and the postoperative chest drainage were significantly less than those in control group( P <0.01). Conclusion In order to protect platelet and organs of the body, administrating aprotinin in operation of beating open-heart surgery with cardiopulmonary bypass is recommended.