The Topical Use of Aprotinin in Cardiac Surgery with Cardiopulmonary Bypass

摘要

Objective To investigate the effects of the topical use of aprotinin on the basis of comprehensive blood conservations in cardiopulmonary bypass (CPB). Methods In a prospective clinical trial, 20 patients were randomly divided into 2 groups. Control group: placebo was used topically. Aprotinin group: aprotinin was poured into the pericardial cavity before closure of the sternotomy. Before and 24h after surgery, hemoglobin (Hb), hematocrit (Hct), bleeding time (BT), clotting time (CT) and prothrombin time (PT) were measured. Meanwhile, amounts of the mediastinal drainage and the hemoglobin loss were observed at 0, 2, 6 and 24h after operation. The samples from the mediastinal drainage were also collected to measure D-Dimer (D-D), tissue type plasminogen activator (t-PA) activity, plasminogen activator inhibitor (PAI) activity and protein C (PC). Results In Aprotinin group, D-D, t-PA activity and PC were significantly reduced, compared with those in Control group (P<0.05, P<0.05, P<0.01). On the contrary, PAI activity was significantly increased, compared with that in Control group. Amounts of the mediastinal drainage and the hemoglobin loss were decreased by 43% and 52%, compared with those in Control group. Conclusion Our results suggest that the topical use of aprotinin can have better effects on the basis of comprehensive moderate blood conservation.