氨甲环酸与抑肽酶在小儿体外循环中对鸟苷一磷酸140影响的比较研究

目的观察并比较氨甲环酸和抑肽酶在体外循环（CPB）中对鸟苷一磷酸140（GMP-140）及CPB后失血的影响。方法随机选取先天性心脏病首次手术患者45例，分为氨甲环酸组（T组）、抑肽酶组（A组）和对照组（S组）各15例。分别于CPB开始前、中、后测定血小板表面GMP-140的含量，并记录各组术后纵隔心包引流量。结果CPB结束、手术结束2hGMP-140的阳性率T、A两组与S组比较差异均有显著意义（P〈0.05）；T、A两组间差异无显著意义。T组在术后3h的累积胸腔和心包引流量与S组比较差异有显著意义（P〈0.05）。A组在术后1h、3h的胸腔和心包引流量与S组相比较差异均有显著意义（P均〈0.05）。结论氨甲环酸与抑肽酶相似，均能明显抑制CPB对GMP-140的激活．保护血小板功能，并可显著减少术后失血。

Comparative analysis of effects of tranexamic acid and aprotinin therapy on guanosine monophosphate 140 during cardiopulmonary bypass

Objective In a prospective study we measured guanosine monophosphate 140(GMP-140) and postoperative hemorrhage among three groups to comparative tranexamic acid and aprotinin therapy effects during cardiopulmonary bypass(CPB).Methods Forty-five patients who underwent CPB were randomly assigned into three groups:group T(tranexamic acid therapy group),group A(aprotinin therapy group) and group S(control group) .Blood samples were obtained through a venous catheter pre,during,and following CPB.The expression of GMP-140 was measured using flow cytometry in platelet-rich plasma(PRP).A full blood count including mean platelet volume(MPV) was taken.We also measured amount of hemorrhage at five points of postoperation.Results At the end of CPB and 2 hours after surgery,between group T and group S,there were significant decrease of GMP-140 expression(P<0.05),and group A also(P<0.05).Compared group T to group S,at the point of 3 hours after operation,the amount of postoperative hemorrhage was significantly decreased(P<0.05).Compared group A to group S,at 1 hour point postoperation,the amount of postoperative hemorrhage was significantly decreased(P<0.05),and 3 hours point postoperation(P<0.05).Conclusions Our data suggest that tranexamic acid therapy and aprotinin therapy groups have the same benefits to GMP-140 and platelet function protection in extracorporeal circulation.Both of them could decrease postoperative hemorrhage volume.Using tranexamic acid therapy instead aprotinin therapy can also decrease cost-effect rate.