抑肽酶对家兔全脑缺血-再灌注期白细胞介素-8基因的影响

目的 观察抑肽酶对家兔全脑缺血－再灌注期血清白细胞介素（IL）－8合成和释放的影响,并探讨其脑保护机制。方法 利用“六血管”阻断建立全脑缺血模型,24只家兔随机分为假手要组（A组）,缺血－再灌注组（B组）和抑肽酶组（C组）,每组8只兔。C组缺血30min再灌注4h,缺血前静注抑肽酶30000kIU/kg,随后每小时微量泵输注抑肽酶10000kIU/kg直至实验结束,B组为缺血－再灌注组,A组仅分离血管不阻断血流。分别在缺血前15min(10)及再灌注30min（R1）、2h（R2）和4h（R3）取颈内静脉血,测定血清IL－8浓度,实验结束取皮层苏木素－伊红染色,光镜观察白细胞浸润及神经元损伤程度。结果 C组IL－8随再灌注时间延长差异无显著性。B组由R1时的0.89ng/L迅速上升至R3时的1.46ng/L,分别增加2.28、2.97、3.74倍,同C组和A组相比差异有显著性;光镜下C组白细胞浸润及神经元损伤程度较B组明显减轻。结论 抑肽酶能有效抑制IL－8的合成和释放,这可能是抑肽酶减轻脑缺血－再 灌注损伤的重要机制。     

抑肽酶对体外循环心脏手术患者细胞因子的影响

目的 观察不同剂量抑肽酶对体外循环心肺转流（CPB）期间促炎细胞因子TNF-α、IL-6和抗炎细胞因子IL-10血浆浓度的影响及作用差异。方法 32例瓣膜置换术病人随机分为三组：对照组、小剂量抑肽酶组和大剂量抑肽酶组。分别于CPB前、CPB结束、停CPB后2小时取桡动脉血测定TNF-α、IL-6、IL-10血浆水平。结果 于CPB结束、停CPB后2小时,大剂量组TNF-α、IL-6血浆水平低于相应点小剂量组,而IL-10血浆水平高于小剂量组。结论 大剂量抑肽酶较小剂量抑肽酶能更有效地抑制TNF-α、IL-6释放、促进IL-10释放,对其抗炎性能有益,抑肽酶的抗炎作用存在量效关系。     

含抑肽酶灌注液减轻缺血再灌注心肌的损伤

目的　观察抑肽酶等药物对缺血再灌注离体兔心的影响。方法　 2 4只家兔随机分为两组 :对照组 (B组 )将离体心脏置于 L angendorfl装置 ,经主动脉逆行灌注克氏液 ,灌注 30 min后 ,用 Thomas灌注停跳 40 min,最后再恢复灌注 30 min。用药组 (A组 )克氏液中加入抑肽酶及山莨菪碱。缺血前及再灌注期记录左心室功能及冠状动脉血管阻力 ,并行心肌超微结构观察。结果　再灌注后 30 min,A组左心室功能明显高于 B组 (P<0 .0 5 ) ;收集的灌注液中肌酸磷酸激酶 (CK)及乳酸脱氢酶 (L DH)较 B组明显减少 ;超微结构改善也优于 B组。结论　抑肽酶对缺血再灌注心肌功能有明显保护作用     

Comparison of aprotinin and tranexamic acid in adult scoliosis correction surgery

Purpose

A retrospective review of consecutive adult patients undergoing scoliosis correction surgery was performed to compare the effects of aprotinin and tranexamic acid in blood conservation and to define a comprehensive blood conservation strategy for such surgery.

Methods

Medical records of all patients who underwent scoliosis correction surgery in this unit between January 2003 and December 2008 were reviewed. The patients were divided into three cohorts: group 1 receiving no antifibrinolytics, group 2 aprotinin and group 3 tranexamic acid. Information was collected regarding number of vertebral levels fused, pre- and post-operative haemoglobin, intra-operative blood loss and peri-operative autologous and allogenic blood transfusion performed.

Results

Aprotinin was used in 28 patients (38%), tranexamic acid in 26 (36%), while 19 (26%) received no antifibrinolytics. 21 patients had anterior surgery, 34 patients had posterior surgery and 18 had combined anterior and posterior procedures. Mean blood loss in the patients who received aprotinin and tranexamic acid was 710 and 738 ml, respectively. This was significantly less than the patients receiving no antifibrinolytics (972 ml, p = 0.037). Blood transfusion was required in only two patients undergoing anterior correction surgery.

Conclusion

Aprotinin and tranexamic acid reduce blood loss in adult spinal deformity correction surgery. With aprotinin being unavailable for clinical use, we recommend the use of tranexamic acid along with other blood conservation measures for adult spinal deformity correction surgery.     

Influence of aprotinin on early graft thrombosis in patients undergoing myocardial revascularization

One hundred sixty-five patients undergoing primary myocardial revascularization were prospectivelyentered into a randomized, double-blind, placebo-controlled study, in a single institution, in order to determine the influence of high- and low-dose aprotinin application on early coronary artery bypass graft patency. All patients were operated on by the same team and the three treatment groups were comparable in all demographic data and surgical variables. Postoperative chest tube drainage and transfusion requirements were significantly reduced in patients receiving high or low doses of aprotinin. In all patients vein and internal mammary artery graft patency was assessed by control coronary angiograms 4 to 15 days (median 8.2 days) postoperatively. In the high-dose aprotinin group, 140 of 142 vein grafts and in the low-dose aprotinin group all of the 128 vein grafts were patent compared with 138 of 139 in the placebo group. The difference was not statistically significant (P> 0.05). All pedicled internal mammary artery grafts were patent in the three treatment groups. The prevalence of perioperative myocardial infarction was evaluated by serial creatine kinase-myocardial band (CK-MB) isoenzyme measurements and by electrocardiographic recordings. No additional changes that could be attributed to aprotinin were observed. In conclusion, these results suggest that perioperative myocardial infraction secondary to aprotinin-induced native coronary artery or conduit thrombosis is not increased by aprotinin in patients undergoing primary myocardial revascularization.     

抑肽酶对体外循环期间血小板保护作用的电镜观察

体外循环心内直视手术病人２０例，随机分为对照组和实验组，每组１０例。对照组行常规体外循环心脏手术，实验组给予抑肽酶处理。取围手术期２个时段血小板行电镜观察，并行统计学处理。结果表明：对照组血小板明显聚集、脱颗粒、破碎、微管扩张；实验组应用抑肽酶后血小板超微结构的变化显著优于对照组。作者认为抑肽酶是一个效果确切的体外循环期间血小板保护药物。     

氨力农及抑肽酶对瓣膜置换术患者围术期白细胞粘附分子表达的影响

目的　了解氨力农和抑肽酶对瓣膜置换手术患者围术期白细胞粘附分子表达的影响。方法　将接受瓣膜置换手术的 32例患者随机分为对照组、抑肽酶 组、抑肽酶 组和抑肽酶加氨力农组 ,每组 8例。分别在术前、停机、停机后 1小时及术后 1天抽取患者外周血 ,用流式细胞仪测定白细胞粘附分子表达情况。结果　术前 4组患者血浆中 CD11b+/CD18+水平无明显差异 (P>0 .0 5 )。术后血浆中 CD11b+/CD18+水平均明显增高 (P<0 .0 1)。停机后 1小时的 CD11b+/CD18+水平组间差异无统计学意义 (P>0 .0 5 )。结论　尽管氨力农和抑肽酶均有抗炎症的效应 ,但仅预充液中加入抑肽酶或同时静脉滴注抑肽酶或在此基础上联合应用氨力农 ,均难以完全抑制瓣膜置换手术患者围手术期白细胞粘附分子 CD11b/CD18的表达增加     

小剂量抑肽酶在体外循环中对血小板功能的保护作用

本文取３０例患者，随机分为两组（每组１５例），对照组预充液中加入等量的生理盐水；实验组预充液中一次性加入１５～２０×１０６ＫＩＵ抑肽酶。观察两组转机前后血小板计数和平均体积及血小板粘附、聚集功能。结果为转机后血小板数量变化不大，对照组的血小板功能较实验组明显下降。实验组的出血量及输血量较对照组低，表明小剂量抑肽酶能够保护转机期间血小板功能，减少术后出血。     

肝癌常规切除术中抑肽酶的血液保护作用

目的 探讨抑肽酶在常规肝癌切除术中的价值。方法 82例常规肝癌切除手术病例，随机分为两组，试验组(A组，40例)在麻醉诱导后静注抑肽酶1 112EPU后持续泵注抑肽酶278EPU／h，直至手术后2h停药；对照组(B组，42例)持续泵注生理盐水。在诱导前、手术开始O．5h、2h、4h、术后6h、12h抽血检测血常规、血栓弹性描记图(TEG)、凝血四项指标。观察两组围术期的’lEG和凝血功能检查变化情况以及术中出血量、围术期输血率和平均输血量。结果 使用抑肽酶之后，试验组的术前高凝状态缓解，术中凝血功能状态保持相对的稳定。而对照组在手术后高凝状态进一步加重，部分病例手术后期及术后呈现低凝状态。试验组在术中出血量、围术期输血率和平均输血量都明显少于对照组。结论 常规肝癌切除手术中抑肽酶可稳定凝血功能状态；减少围手术期出血及输血。     

抑肽酶对体外循环中性粒细胞CD11b表达的研究

目的探讨抑肽酶对体外循环(CPB)全身炎性反应的抑制作用.方法 16例心脏瓣膜替换术患者随机分为对照组和抑肽酶组,各8例,于手术开始前、CPB转流中40min、CPB转流后30min、CPB结束后4h用流式细胞仪测定肝素化动脉血中性粒细胞整合素CD11b的表达.结果对照组在CPB结束后30min、CPB结束后4h,CD11b的表达明显高于手术开始前(P＜0.01)及抑肽酶组相同时间点(P＜0.01).结论在CPB术中抑肽酶可抑制中性粒细胞CD11b表达的上调,减轻免疫炎性反应的发生.