抑肽酶对非体外循环冠脉搭桥术病人凝血功能和血小板功能的影响  

Effect of aprotinin on coagulation and platelet function in patients undergoing off-pump coronary artery bypass

作　　者：纪宏文[1] 陈雷[1] 刘进[2] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院麻醉科,北京市100037 [2]四川大学华西医院麻醉科

出　　处：《中华麻醉学杂志》2006年第8期696-699,共4页Chinese Journal of Anesthesiology

摘　　要：目的研究抑肽酶对非体外循环冠脉搭桥术(OPCAB)病人凝血功能及血小板功能的影响。方法择期行OPCAB病人32冽,ASAⅢ或Ⅳ级．年龄46～75岁,体重65～92 kg,随机分为2组(n =16)：对照组(C组)和抑肽酶组(A组)。C组不用任何抗纤溶药物,A组将抑肽酶200万KIU溶于100 ml生理盐水中,自切皮开始静脉输注,30min内输注完毕．另外100万KIU以20～30万KIU/h速率输注至术毕。分别于切皮前1min、肝素化前1 min(此时已用抑肽酶200万KIU)、术毕、术后6h和术后24 h经颈内静脉采血5 ml,用流式细胞仪测定血小板膜糖蛋白GPU b/m a和血小板α颗粒膜蛋白-140 (CD62p),用比浊法测定部分凝血活酶时间(APTT)、凝血酶原时间(PT)和纤维蛋白原,用硅藻十激活剂测定激活全血凝固时间(ACT)。记录术后24 h出血量。结果组间GPⅡb/Ⅲa、FT和ACT比较差异无统计学意义(P＞0．05)。与C组比较,A组CD62p肝素化前1 min、术毕和术后6h降低,APTT肝素化前1 min和术毕时延长,术后24 h出血量减少(P＜0．01)。结论抑肽酶抑制OPCAB病人血小板激活和内源性凝血系统,减少术后出血。Objective To evaluate the effect of aprotinin on coagulation and platelet function in patients undergoing off-pump coronary artery bypass（CAB）. Methods After institutional review board approval and written informed consent, 32 ASA Ⅲ or Ⅳ, NYHA Ⅱ or Ⅲ patients （27 male, 5 female ） aged 46-75 yrs weighing 62- 92 kg undergoing off-pump CAB were assigned to one of two groups （n = 16 each）： control group （C） and aprotinin group （A）. In group A aprotinin 2 × 10^7 KIU in 100 ml of normal saline was infused iv over 30 min starting from skin incision. Another 107 KIU of aprotinin was infused at a rate of 2-3 × 10^5 KIU. h^- 1 until the chest was closed. Venous blood samples were taken at the following time points ： 1 min before operation （baseline T0 ）, 1 min before heparinization （T1 ）, at the end of operation（T2 ）, 6 h after operation（T3 ） and 24 h after operation （T4）. Platelet membrane glucoprotein Ⅱ b/Ⅲ a （GP Ⅱ b/Ⅲ a） and platelet a granule membrane protein-140 （CD62p） were measured by flow cytometry. APTF, PT, ACT, fibrinogen and platelet count were also measured. Postoperative blood loss and allogeneic blood transfusion were recorded. Results There were no significant differences in demographic data including sex, age, body weight and duration of operation. CD62p a platelet activation marker was significantly lower at T1 , T2 and T3 in group A than in group C （ P 〈 0.01 ）. There were no significant differences in GP Ⅱ b/Ⅲ a, PT and ACT between the two groups. APTT was significantly prolonged at T2 and T2 in group A as compared to group C （ P 〈 0.01 ）. The total amount of blood loss in 24 h after operation was （364 ± 132）ml in group A and （957 ± 344）ml in group C （P 〈 0.01 ）. The total amount of allogeneic blood infused was （98 ± 75）ml in group A and （436 ± 315）ml in group C （ P 〈 0.01）. Conclusion Aprotinin inhibits platelet activation and preserves platelet function. It has anticoagulation property

关 键 词：抑肽酶 冠状动脉分流术 心肺转流术 血液凝固 血小板功能试验 

分 类 号：R614[医药卫生—麻醉学]