抑肽酶在体外循环心脏外科的临床应用  

The Clinical Application of Aprotinin in Open Heart Surgery under Cardiopulmonary Bypass

作　　者：华东平[1] 朱洪生[1] 俞美娟[1] 葛云霞[1] 陈宗南[1] 王一山[1] 

机构地区：[1]上海第二医科大学附属仁济医院心胸外科

出　　处：《中华胸心血管外科杂志》1995年第1期25-27,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：通过在体外循环心脏手术中应用抑肽酶的临床研究（对照组ｎ＝２０；抑肽酶组ｎ＝５０）结果显示：抑肽酶能有效地保护血小板的功能，避免血小板在体外循环转流时的活化释放及损耗，并减轻血小板数量的下降；抑肽酶还可抑制纤溶系统的激活，与肝素有协同作用，使ＡＣＴ延长，并可减少肝素及鱼精蛋白的用量，最终达到明显减少术后失血量（６３％）及术后输血量（５４％）与输血浆量（４２％）之目的。Clinical study in 2 groups of patients(C Control n=20;A Aprotinin n=50,total dose of 3000000 to 3500000 KIU each).The results showed:1.Post OPPLT count in A was markedly higher than that in C(88vs 54×109/L)(P<0.05).2.PLT aggregation induced by collagen in A was more obvious than that in C(42.9% vs 28.8% after heparinization;29.4/00 vs 18.3%30min after CPB)(P<0.05).3.TXB2 and TXB2/6-ke-to-PGF1(were significantly increased in C as compared with A(897 vs 366 ng/L and 9.2vs 3.9)(P<0.01).4. Plasminogen and plasmin during CPB in A were decreased as compared with C(183 vs 254 mg/L;40.9 vs 45.2u) P<0.01 and P<0.05 respectively.5.ACT was markedly prolonged in A(1104s.)compared wit C(644s.)during CPB (P<0.01).However,on the contrary the amount of heparin and protamine used in A were markedly reduced(P<0.01).6.The average amount of chest drainage, blood and plasma transfusion in C post OP were 880,922 and 133ml;Yet in A 326428 and 78ml(P<0.01) respectively.Thus the respective percentage of reduction were 63%,54%and 42%.Conclusion:aprotinin provides effective protection for platelet count and function,as well as inhibition of fibrinolysis during CPB.It also had an influence on ACT prolongation and decresed amount of heparin and protamine used.Aprotinin can markedly reduce postoperative oozing and chest drainage,resulting in the reduction of blood and plasma transfustion.

关 键 词：抑肽酶 血小板 止血 体外循环 心内直视术 

分 类 号：R654.1[医药卫生—外科学] R977.3[医药卫生—临床医学]