抑肽酶与冠脉搭桥术围术期心梗相关性的初步观察  

Preliminary observation of correlation between aprotinin and perioperative myocardial infarction in patients undergoing coronary artery bypass grafting

作　　者：叶晓青[1] 黄小蝶[1] 王辉[1] 张莉莉[1] 

机构地区：[1]深圳市孙逸仙心血管医院,广东深圳518020

出　　处：《药物不良反应杂志》2005年第4期250-252,共3页Adverse Drug Reactions Journal

摘　　要：目的:观察冠状动脉搭桥手术(CABG)患者术中应用抑肽酶是否引起围术期心肌缺血甚至心肌梗死。方法:11例择期冠状动脉搭桥术者,均浅低温体外循环(CPB),预充抑肽酶500万KIU。6例灌注4∶1冷含血心脏停搏液(10～15℃),5例单次灌注4℃组氨酸-色氨酸-α酮戊二酸(HTK)液。于麻醉诱导后、CPB停机前、术后2h、第1天、第2天分别采取外周血,用酶联免疫法测定血清磷酸肌酸激酶同工酶(CK-MB)含量。并观察记录异常心电图及胸痛主诉。结果:CPB中至术后第一天CK-MB均显著升高,第二天均恢复正常。5例于术后第一、二天有短暂不典型的ST抬高,全体无胸痛主诉。1例死于呼吸衰竭,其余痊愈出院。结论:未能观察到CABG患者应用大剂量抑肽酶增加围术期心肌梗死的危险。Objective： To observe if aprotinin therapy is associated with increased risk of perioperative myocardial infarction in patients undergoing coronary artery bypass grafting （CABG）. Methods： 11 patients scheduled for CABG received mild hypothermia cardiopulmonary bypass （CPB）and aprotinin 5 million kalhkrein-inhibiting units. 6 cases were perfused with cold blood cardioplegic solution and others were perfused with HTK solution. Creatine kinase-MB （CK-MB） were detected and abnormal electrocardiogram and chest pain were recorded during and after operation. Results. CK-MB increased significantly during CPB and on the first day after operation and returned to normal on the second day after operation. All patients didn＇t complain of chest pain, and an ECG showed transient ST-segment elevation in 5 cases. One patient died of respiratory failure and others recovered . Conclusion： There is no proof that the use of large-dose aprotinin can increase the risk of perioperative myocardial infarction in patients undergoing coronary artery bypass grafting.

关 键 词：抑肽酶 冠状动脉搭桥术 心肌梗死 

分 类 号：R654.2[医药卫生—外科学]