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作 者:袁林辉[1] 唐燕华[2] 李昌[1] 朱晓红[1] 马长华[1] 徐国海[1]
机构地区:[1]南昌大学第二附属医院麻醉科,南昌330006 [2]南昌大学第二附属医院心胸外科,南昌330006
出 处:《南昌大学学报(医学版)》2010年第3期67-69,共3页Journal of Nanchang University:Medical Sciences
摘 要:目的探讨体外循环手术患者应用抑肽酶的临床效果及安全性。方法以中国食品及药品监督局下令暂停抑肽酶在心脏外科临床使用的日期(2007年12月19日)为分界点,回顾性分析停药前后1年的患者临床资料。选择2006年12月19日至2007年12月18日行体外循环手术患者为抑肽酶组(n=360),在术中均应用抑肽酶;2007年12月19日至2008年12月18日行体外循环手术患者为对照组(n=360),在术中均未使用抑肽酶。对2组患者体外循环、主动脉阻断时间,术后出血量、输血量、呼吸机使用时间、术后24 h氧分压指数,二次开胸、术后肾功能不全、术后低心排出量综合征、延迟拔管、术后严重肺部感染等发生率及住院病死率进行比较。结果 2组患者手术种类、体外循环时间、主动脉阻断时间,肾功能不全、低心排出量综合征发生率,住院病死率的比较差异均无统计学意义(均P>0.05)。抑肽酶组术后出血量、输血量、呼吸机使用时间,二次开胸、延迟拔管、严重肺部感染发生率均低于对照组(均P<0.05);术后24 h氧分压指数高于对照组(P<0.05)。结论体外循环手术应用抑肽酶是安全有效的,可明显减少术后出血量及输血量,且对肺功能有一定的保护作用,并没有增加病死率及并发症发生率。所以,在中国是否应该停用抑肽酶还需要国内做一些大样本、多中心的临床研究来验证。Objective To investigate the effect and the safety of aprotinin on outcomes in patients undergoing cardiopulmonary bypass.Methods Retrospective analysis the patients who underwent cardiopulmonary bypass during one year before and after the date,aprotinin was suspended in China,Dec 19,2007.Aprotinin group(n=360)was defined as operations from Dec 19,2006 to Dec 18,2007,aprotinin was used in the operations.Control group(n=360)was defined as operations from Dec 19,2007 to Dec 18,2008.aprotinin was not used.Postoperative outcomes between the two groups were compared,including extracorporeal circulation time,aortic cross-clamping time,blood loss,blood transfusion requirement,ventilating time,oxygen index of 24 hours postoperation,reoperation rate,in-hospital mortality,incidence rate of renal inadequacy,low cardiac output syndrome,prolonged extubation and severe pulmonary infection.Results There were no differences between the two groups for the operation types,extracorporeal circulation time,aortic cross-clamping time,incidence rate of renal inadequacy,low cardiac output syndrome,and in-hospital mortality(all P0.05).As compared with the control group,aprotinin group had lower blood loss,blood transfusion requirement,ventilating time,reoperation rate,incidence rate of prolonged extubation and severe pulmonary infection(all P0.05);And had a higher oxygen index of 24 hours postoperation(P0.05).Conclusion Application of aprotinin is effect and the safety,could reduce blood loss and transfusion requirement,and provided a protective effect on the lungs.It did not increase the risk of in-hospital mortality and morbidity.We suggest whether stopping the ues of aprotinin in China need further studies.
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