先天性心脏病手术中的抗纤溶治疗  

作　　者：Michael P. Eaton, mD 桂波(译) 钱燕宁(校) 

机构地区：[1]Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York [2]不详

出　　处：《麻醉与镇痛》2011年第2期40-54,共15页Anesthesia & Analgesia

摘　　要：现已公认丝氨酸蛋白激酶抑制剂（抑肽酶）和赖氨酸类物质（氨基己酸和氨甲环酸）能降低成年患者行心脏手术的出血量和输血量。儿童行心脏手术时出血和输血的风险均很大，但上述治疗对儿童的风险和益处尚不清楚。目前已有调查先天性心脏病抗纤溶治疗的大量文献，但因受试患者、程序、方法和剂量等方面存在的巨大差异，使此类文献不能进行定量分析。定性分析此类文献支持这3种药对减少先天性心脏病手术的出血量和输血量有显著作用，并且似乎对特定人群有更多的益处。有限的数据提示这3种药之间的疗效没有差异。尽管抑肽酶可能有独特的抗炎作用而对儿童患者有益，但是有限的数据显示这3种药物的疗效之间无差异。虽然抑肽酶致儿童过敏反应的风险可能低于成人，但尚无足够证据证实儿童使用这些药物是安全的。尽管已有这些药物的药代学和药效学数据，但这些药物的剂量方案变化很大，并不总是按照药理学原则。所以进一步的研究应该直接针对安全性、两类药物的相对疗效、对特定患者的益处及更好地确定有效剂量方案等方面进行。The efficacy of the serine protease inhibitor, aprotinin, and the lysine analogs, ε-aminocaproic acid and tranexamic acid, in reducing bleeding and transfusion in adults undergoing cardiac surgery is well established. Although children undergoing cardiac surgery are dearly at high risk for bleeding and transfusion, the risks and benefits of this therapy for the pediatric population are less well Understood. There is a reasonable body of literature examining antifibrinolytic therapy in congenital heart surgery, but the large variability in patients studied, procedures, methods, and dosing schemes makes a quantitative analysis of this literature impractical. A qualitative review of this literature reveals significant support for the efficacy of all three drugs for decreasing bleeding and transfusion in congenital heart surgery, likely with more benefit in certain populations. Limited data suggest that there is no difference in efficacy among the three drugs, although aprotinin may have unique antiinflarnmatory effects that are of benefit in pediatric patients. There is not enough evidence to draw any conclusions about the safety of these drugs in children, although it appears that the risk of anaphylaxis with aprotinin in children may be less than in adults. Dosing schemes used for these drugs have been variable and not always based on sound pharmacologic principles, despite available pharmacokinetic and pharmacodynamic data. Further research should be directed toward establishing safety, evaluating the relative efficacy of the two classes of drugs, proving benefit in specific patient groups, and better defining effecxive dosing schemes.

关 键 词：先天性心脏病手术 抗纤溶治疗 手术中 蛋白激酶抑制剂 儿童患者 成年患者 数据显示 剂量方案 

分 类 号：R814.3[医药卫生—影像医学与核医学]