抑肽酶的血液保护作用在食管癌根治术麻醉中的使用价值

Clinical value of aprotinin blood anesthesia in radical excision of esophageal carcinoma

目的 探讨抑肽酶在食道癌根治术中减少出血量、输血量的价值。方法采用单盲法设计,90例食管癌择期手术病例,根据是否使用了抑肽酶分为两组:实验组(A组,40例)在麻醉诱导后静注抑肽酶1 112 EPU后持续泵注抑肽酶278EPU/h,直至手术后2 h停药;对照组(B组,50例)持续泵注生理盐水。在诱导前、手术开始2、4 h、术毕、术后12 h时相点上抽血检测血常规、血栓弹性描记图(Thromboelastography,TEG)、凝血四项指标。观察两组围术期的TEG和凝血功能检查变化情况以及术中出血量、围术期输血率和平均输血量。结果 实验组在术中出血量、围术期输血率和平均输血量都显著少于对照组(P<0.05),凝血功能状态保持相对的稳定。结论 抑肽酶血液保护作用的运用在食管癌根治手术中具有稳定凝血功能状态、减少围手术期出血量、输血量和输血率的作用,具有较高的应用价值。

Objective To investigate the clinical value of aprotinin blood anesthesia in the radical excision of esophageal carcinoma. Methods A total of 90 patients with esophageal carcinoma undergoing radical excision were divided into two groups according to using aprotinin or not. Patients in experiment group (group A, 40 patients) were injected with 1 112 EPU aprotinin followed by constant pumped infusion of 278 EPU/h until 2 h after operation. Patients in the control group (group B, 50 patients) were treated with constant pumped infusion of 0.9% saline. The venous blood was collected for blood routine examination, thromboelastography(TEG) and normal coagulable function test at the following time points: before induction, at 2 h and 4 h after the beginning of operation, at the end of operation and at 12 h after operation. The changes of TEG and normal coagulable state were monitored during the whole surgical process. The intraoperative volume of hemorrhage, perioperative transfusion rate and average volume of transfusion in the two groups were compared. Results The preoperative coagulable state in experiment group was kept relatively stable during the operation. Volume of intraoperative hemorrhage, perioperative transfusion rate and average volume of blood transfusion in experiment group were significantly lower than those in the control group. Conclusion Aprotinin blood anesthesia can stabilize the coagulable state, reduce the volumes and rates of hemorrhage and transfusion, and hence can find wide application in the radical excision of esophageal carcinoma.