개심술에 있어서 Low-Dose Aprotinin의 투여 효과

Abstract

Excessive blood loss secondary to cardiopulmonary bypass(CPB) may be encountered after open heart surgery and platelet dysfunction appears to be especially responsible for this problem. To evaluate the effect of low-dose aprotinin during hypothermic CPB on platelet aggregation, anticoagulation and clinical hemostasis,.40 patients undergoing valve replacement using hypothermic CPB procedures were randomized to give either a low dose aprotinin(2x 106 KIU in the CPB priming sol- ution, n=20) or a placebo(n=20). During postoperative 24 hours, blood and hemoglobin loss were lower in the aprotinin group (225.5 ± 121.9ml, and 11.3±2.4g) than the control group(572.2±)35.5ml and 26.3±9.8g)(P<0.01). The total blood and hemoglobin loss were lower in the aprotinin group (622.0± 186m1 and 14.7±6.8g) than the con- trol group (102.1 ±483.5ml and 39.7± 16.4g) (P<0.01). The amonut of packed red cell needed decreased in the aprotinin group: 197.7±56.3ml vers s 651.2: 147.5ml (P<0.01). Hemoglobin concentration, platelet counts and fibrinogen checked at fixed times perioperatively did not differ between the two groups. Platelet aggregation was induced by ADP, collagen, epinephrine and ristocetin before and after CPB. Maximum platelet aggregation was significantly reduced after CPB in control group (ranging from -31 % to -58% relative to prebypass values). Significant prolongation of activated clotting time(ACT) after 5 minute and 30 minute of hypothermic CPB were observed: 955.9 ±35.1 and 967.5±32.7sec versus 743.8 ± 52.1 and 731.2: 54.6sec (P<0.01). There was no complication associated with aprotinin infusion. These results demonstrate that low-dose aprotinin significantly reduces blood loss and blood requirment and provides improved postoperative hemostasis which might be related to protection of platelet aggregation capacity.

체외순환을 이용한 개심술후 혈소판기능부전에 의한 비정상적인 출혈은 수술 사망율 및 이환율의 증가를 초래한다. 본 논문에서는 체외순환시 aprotinin을 투여하여 임상적 지혈 및 혈소판기능보존에 대한 효과를 관찰하기 위해 인공판막치 환술을 받은 40명의 환자를 대상으로 low-dose aprotinln 투여군 20명, 대조군 20명으로 나누어 그 효과를 비교 분석하였다. Aprotinin 투여군에서 대조군에 비해 약 40%의 출혈감소(622.0± 186m1 versus 1021 ±483.5ml, p<0.01) 및 약 63%의 혈색소 손실(14.7 ±6.8g versus 39.7± 16.4g, p<0.01)을 줄일 수 있었으며 약 70%의 수혈감 소(197.7± 56.3ml versus 651.2 ± 147.5ml, p<0.01) 효과를 얻을 수 있었다. 또한 투여 군에서 혈소판 응집 능이 효과적으로 보존되었다(P<0.05). 체외순환중 activated clotting time이 투여 군에서 연장되어 heparin의 항응고작용에 대해 상승효과가 있었으며 aprotinin의 투여와 관련된 합병증은 없었다. 이상의 결과에서 체외순환을 이용한 개심술에 있어서 low-dose aprotinin의 투여는 술후 출혈량 및 혈 액과 혈액제제의 사용감소에 효과가 있으며 이는 혈소판응집능의 효과적 ┌보존에 의한 것으로 사료된다.