在深度低温循环停止中,阿普罗丁宁,血液损失和功能障碍
C T Mora Mangano1, M J Neville, P H Hsu
1Department of Anesthesia and Cardiothoracic Surgery, Stanford University, Stanford, California, USA. cmoraman@stanford.edu
Circulation
|September 25, 2001
概括
在深度低温循环停止 (DHCA) 患者中,阿普罗丁素不会增加功能障碍的风险,但不会减少血液损失. 输血和尿液输出等因素预测DHCA手术中的脏问题.
科学领域:
- 心胸外科手术 心胸外科手术
- 心血管外科心血管外科
- 腎臟病學 (nephrology) 是一種醫學專業.
- 麻醉学 麻醉学
背景情况:
- 在心胸外科手术中,深度低温循环停止 (DHCA) 会增加流血和功能障碍的风险.
- 作为一种血清蛋白酶抑制剂的阿普罗丁宁用于减少血液损失,但由于脏问题,其在DHCA中的安全性仍在争论中.
研究的目的:
- 评估阿普罗丁因对血液输血需求和DHCA进行心血管手术的患者功能的影响.
主要方法:
- 对853名接受大动脉或胸腔腹腔外科手术的患者进行了回顾性审查,重点是203名接受DHCA治疗的患者.
- 对手术前和手术后肌素清除率 (CRCl) 的分析,以将功能障碍定义为25%的减少.
- 多变量回归以确定与功能障碍相关的因素,包括使用阿普罗丁.
主要成果:
- 手术后DHCA显著降低了CRCl (86至67毫升/分钟).
- 38%的患者经历了术后功能障碍.
- 使用阿普罗丁素并没有增加功能障碍 (P=0.951),也没有显著减少输血需求.
- 与功能障碍相关的因素包括更高的红细胞需求,更低的尿量,多巴胺的不使用和更低的血红素.
结论:
- 在DHCA患者中服用阿普罗丁素并不会增加功能障碍的风险.
- 在DHCA中,阿普罗丁因可能无法有效地减少外科手术期间的血液损失.
- 减少尿液产量和增加输血需求是DHCA中术后功能障碍的关键预测因素.
- 多巴胺可能在DHCA期间提供脏保护.
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