Aprotinin의 체외순환에 따른 출혈억제효과 = Effects of Aprotinin on Blood Loss during Cardiopulmonary Bypass

다국어 초록 (Multilingual Abstract)

CPB(cardiopulmonary bypass) is a very complex process ad activated many humoral system which include the coagulation system, firbrinolytic system, kallikrein system, and the complement system, are probably all very important and closely interrelated. It has profound effects the number and especially function of platelets because of contact between blood and gaseous or synthetic solid surface during CPB. These changes increase blood loss after cardiac operations and may transfuse a large amounts of banked blood inevitably which may cause very serious complications including hepatitis and AIDS, etc.
Aprotinin is a proteolytic enzyme inhibitor and depress the activation of fibrinolytic system via a powerful antiplasmin activity and may preserve von Willebrand platelet interaction.
Two groups of patients were prospectively studied to evaluate the hemostatic effects of high dose aporotinin in open heart operation, first group patients(n=10), at the start of anesthesia 2,000,000 kallikrein inactivator units(KIU) of aprotinin was infused over 20 to 30 minutes. Subsequently, 500,000 KIU/h aprotinin was given untill the end of operation. Additionally, 1,000,000 KIU of aprotinin was in the priming solution of the extracorporeal circuit. Second group patients(n=10) served as controls.
The results were as follows,
1. The decrease of hemoglobin and serum protein following CPB was reduced significantly(p<0.05) in aprotinin group.
2. The decrease of platelet number and increase of bleeding time following CPB were reduced in aprotinin group.
3. The intraoperative and postoperative blood loss and the amounts of transfusion of banked blood were reduced significantly(p<0.05) in aprotinin group.
In the conclusion, we believe that the use of high dose aprotinin decreases blood loss and reduced the need for banked blood in cardiac patients.