Aprotinin in major orthopedic surgery: a systematic review of randomized controlled trials

Aprotinin therapy is a promising strategy for reducing blood loss and blood transfusion requirements. The efficacy and safety of aprotinin in orthopedic surgery, however, remain controversial. We searched electronic databases for randomized controlled trials on the efficacy and safety of the use of aprotinin in orthopedic surgery. Thirteen trials that included a total of 506 patients who underwent major orthopedic surgery were analyzed. The pooled intraoperative and perioperative blood loss was significantly less in the aprotinin-treated patients than in the control patients (weighted mean difference [WMD] for intraoperative blood loss = -229 mL, 95% confidence interval [CI] = -367 to -91 mL, P = 0.0011; WMD for perioperative blood loss = -557 mL; 95% CI = -860 to -254 mL; P < 0.0001). The pooled amounts of red blood cell (RBC) units (U) transfused intraoperatively and perioperatively were significantly less in the aprotinin-treated patients than in the control patients (WMD for intraoperative RBC U = -1.1 U; 95% CI = -1.7 to -0.4 U; P = 0.0001; WMD for perioperative RBC U = -1.1 U; 95% CI = -1.7 to -0.5 U; P < 0.0001). Aprotinin was not associated with an increased incidence of deep vein thrombosis (odds ratio = 0.39; 95% CI = 0.14 to 1.05, P = 0.061). The authors conclude that aprotinin reduces the intraoperative and perioperative blood loss and allogeneic blood transfusion requirement and may not be associated with increased risk of deep vein thrombosis in the presence of pharmacological or mechanical prophylaxis in patients undergoing major orthopedic surgery.     

Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery

BACKGROUND: Intraoperative hypovolemia is common and is a potential cause of organ dysfunction, increased postoperative morbidity, length of hospital stay, and death. The objective of this prospective, randomized study was to assess the effect of goal-directed intraoperative fluid administration on length of postoperative hospital stay. METHODS: One hundred patients who were to undergo major elective surgery with an anticipated blood loss greater than 500 ml were randomly assigned to a control group (n = 50) that received standard intraoperative care or to a protocol group (n = 50) that, in addition, received intraoperative plasma volume expansion guided by the esophageal Doppler monitor to maintain maximal stroke volume. Length of postoperative hospital stay and postoperative surgical morbidity were assessed. RESULTS: Groups were similar with respect to demographics, surgical procedures, and baseline hemodynamic variables. The protocol group had a significantly higher stroke volume and cardiac output at the end of surgery compared with the control group. Patients in the protocol group had a shorter duration of hospital stay compared with the control group: 5 +/- 3 versus 7 +/- 3 days (mean +/- SD), with a median of 6 versus 7 days, respectively ( = 0.03). These patients also tolerated oral intake of solid food earlier than the control group: 3 +/- 0.5 versus 4.7 +/- 0.5 days (mean +/- SD), with a median of 3 versus 5 days, respectively ( = 0.01). CONCLUSIONS: Goal-directed intraoperative fluid administration results in earlier return to bowel function, lower incidence of postoperative nausea and vomiting, and decrease in length of postoperative hospital stay.     

Goal-directed Intraoperative Fluid Administration Reduces Length of Hospital Stay after Major Surgery

Background: Intraoperative hypovolemia is common and is a potential cause of organ dysfunction, increased postoperative morbidity, length of hospital stay, and death. The objective of this prospective, randomized study was to assess the effect of goal-directed intraoperative fluid administration on length of postoperative hospital stay.

Methods: One hundred patients who were to undergo major elective surgery with an anticipated blood loss greater than 500 ml were randomly assigned to a control group (n = 50) that received standard intraoperative care or to a protocol group (n = 50) that, in addition, received intraoperative plasma volume expansion guided by the esophageal Doppler monitor to maintain maximal stroke volume. Length of postoperative hospital stay and postoperative surgical morbidity were assessed.

Results: Groups were similar with respect to demographics, surgical procedures, and baseline hemodynamic variables. The protocol group had a significantly higher stroke volume and cardiac output at the end of surgery compared with the control group. Patients in the protocol group had a shorter duration of hospital stay compared with the control group: 5 +/- 3 versus 7 +/- 3 days (mean +/- SD), with a median of 6 versus 7 days, respectively (P = 0.03). These patients also tolerated oral intake of solid food earlier than the control group: 3 +/- 0.5 versus 4.7 +/- 0.5 days (mean +/- SD), with a median of 3 versus 5 days, respectively (P = 0.01).     

全膝关节置换术中应用富血小板血浆的临床效果

目的评价全膝关节置换术中局部应用富血小板血浆的临床效果。 方法检索中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据知识服务平台(WANFANG)、维普资讯中文期刊服务平台(VIP)4个中文数据库和PubMed、Web of Science、荷兰医学文摘数据库(Embase)、循证医学数据库(Cochrane Library)4个外文数据库中公开发表的关于全膝关节置换术中应用富血小板血浆临床疗效的相关文献,按照只纳入随机对照临床试验不纳入综述、非随机试验及动物实验等标准筛选文献,根据文献质量评估标准评价文献,采用标准格式收集数据,运用RevMan 5.3软件对4个结局指标即估计总失血量、膝关节活动度(ROM)、住院时间、术后并发症进行荟萃分析。 结果共纳入7篇随机对照试验,分析结果显示：富血小板血浆(PRP)组估计总失血量比对照组少[均数差(MD)＝-132.32,95%置信区间(CI)(-231.24,-33.40),P＝0.009];PRP组住院时间比对照组短[MD ＝-2.12,95% CI(-3.47,-0.76),P＝0.002];PRP组术后并发症发生率比对照组低[比值比(OR)＝0.45,95% CI(0.22,0.91),P＝0.03]; PRP组膝关节ROM与对照组差异不大[术后2 d：MD ＝0.80,95% CI(-2.87,4.46),P＝0.67;术后3 d：MD ＝1.23,95% CI (-4.12,6.58),P＝0.65;术后5 d：MD ＝2.93,95% CI(-0.60,6.46),P＝0.10;术后7 d：MD ＝2.09,95% CI(-4.63,8.82), P＝0.54;术后2周：MD ＝-0.88, 95% CI(-3.70,1.94),P＝0.54;术后6周：MD ＝3.93,95% CI(-5.17,13.02),P＝0.40;术后3个月：MD ＝1.00, 95% CI(-4.15,6.15),P＝0.70]。 结论全膝关节置换术中应用富血小板血浆时,估计总失血量减少、住院时间缩短、术后并发症发生率降低,但膝关节活动度无明显提高。     

Intensive geriatric rehabilitation of hip fracture patients: a randomized,controlled trial

We determined the effect of geriatric rehabilitation of hip fracture patients on mortality, length of hospital stay, and functional recovery. In a randomized, controlled intervention study, 243 community dwelling hip fracture patients over 64 years of age were randomly assigned to 2 rehabilitation groups. The intervention group (n = 120) was referred to a geriatric ward for team rehabilitation, and the controls (n = 123) to local hospital wards for standard care. The median length of total hospital stay after a hip fracture operation was 34 (95% CI 28-38) days in the intervention group and 42 (95% CI 35-48) days in the control group (p = 0.05). The intervention group recovered instrumental activities of daily living faster (p = 0.05). Direct costs of medical care during the first year did not differ remarkably.     

The effects of a pneumatic tourniquet on blood loss in total knee arthroplasty.

OBJECTIVE: In lower-extremity surgery there are significant risks associated with the use of tourniquets. This prospective study was done to assess to what extent these risks may be offset by the potential advantages of tourniquets, namely reductions in blood loss, length of hospital stay and complication rates. DESIGN: A prospective case study. SETTING: A major urban hospital. PATIENTS: Sixty-three consecutive patients scheduled for primary cemented total knee arthroplasty (TKA) were blindly randomized into tourniqet (n = 33) and non-tourniquet (n = 30) groups. INTERVENTION: TKA during which a pneumatic tourniquet was applied or not applied to control blood loss. MAIN OUTCOME MEASURES: Perioperative blood loss, operating time, complication rates, hospital stay and transfusion needs. RESULTS: Differences in the total measured blood loss, intraoperative blood loss and the Hemovac drainage blood loss between the 2 groups were not significantly different (p > 0.25). The calculated total blood loss was actually lower in the non-tourniquet group (p = 0.02). Between the groups there were no statistical differences in surgical time, length of hospital stay, transfusion requirements or rate of complications (although there was a trend to more complications in the tourniquet group (p = 0.06)). CONCLUSION: The effectiveness of a pneumatic tourniquet to control blood loss in TKA is questionable.     

腹腔镜技术在胃良性疾病中的应用:附68例报道

目的：探讨腹腔镜技术在治疗胃良性疾病中的运用及其临床价值。方法：回顾分析2002年1月至2007年11月行完全腹腔镜治疗的胃良性病病人68例的临床资料（LG组），并与同期92例开腹手术病人（OG组）在平均手术时间、术中失血、术后恢复平均住院天数等方面进行比较。结果：68例LG组病人均在腹腔镜下顺利完成手术。平均手术时间90min，平均出血50ml，平均住院时间6．5d；2例发生切口感染，无其他严重并发症发生。OG组平均手术时间100min（P〉0．05），平均出血95ml（P〈0．05），平均住院时间12d（P〈0．05）；其中7例发生切口感染，3例发生胃排空障碍，并且有1例发生吻合口瘘，1例发生术后肠梗阻。两组相比可见，LG组手术疗效和术后恢复均明显优于OG组。结论：腹腔镜技术在胃良性疾病手术中安全、可行，具有出血少、创伤小、住院时间短的优点，值得推广。     

肝脏肿瘤的微创治疗——从腹腔镜到机器人

目的探讨完全腹腔镜、手助式腹腔镜及机器人三种微创手术方式在肝脏切除术中的可行性、安全性及适用范围。方法回顾性分析上海交通大学医学院附属瑞金医院普外科自2004年9月至20l2年1月期间完成的微创肝脏切除术(minimally invasive liver resection,MILR)128例患者的临床资料,根据手术方式分为完全腹腔镜肝脏切除术(pure laparoscopic resection,PLR)组、手助式腹腔镜肝脏切除术(hand-assisted laparoscopicresection,HALR)组及机器人辅助肝脏切除术(robotic liver resection,RLR)组,分别观察3组患者术中与术后恢复情况并进行对比分析。结果 PLR组82例,中转开腹3例,手术时间为(145.4±54.4)min(40～290 min)、术中出血量为(249.3±255.7)ml(30～1 500 ml),术后并发腹腔感染3例,胆瘘5例,经保守治疗后痊愈,无围手术期死亡,术后住院时间为(7.1±3.8)d(2～34 d)。HALR组35例,中转开腹3例,手术时间为(182.7±59.2)min(60～300 min)、术中出血量为(754.3±785.2)ml(50～3 000 ml),术后并发腹腔感染1例,胆瘘2例,切口感染2例,经保守治疗后痊愈,无二次手术,术后住院时间为(15.4±3.7)d(12～30 d)。RLR组11例,中转开腹2例,手术时间为(129.5±33.5)min(120～200 min)、术中出血量为(424.5±657.5)ml(50～5 000 ml),术后并发腹腔感染1例,胆瘘1例,经保守治疗后痊愈,术后住院时间为(6.4±1.6)d(5～9 d)。3组中,RLR组手术时间最短(P=0.001),术后住院时间最短(P=0.000),PLR组术中出血量最少(P=0.000),其差异均有统计学意义。结论肝脏肿瘤微创切除术安全、可行,临床工作中,需要根据不同的病例选择不同的手术方式。机器人辅助肝脏切除术为肝脏肿瘤的微创治疗带来了新的突破。     

完全腹腔镜下胃良性病手术50例

目的总结腹腔镜下胃大部切除术的可行性、方法及效果并探讨其临床价值。方法回顾分析2002年1月至2006年6月行完全腹腔镜治疗的胃良性病患者50例的临床资料（LG组）,并与同期104例开腹手术患者（OG组）在平均手术时间、术中失血、术后平均住院日及并发症等方面进行比较。结果50例LG组患者手术均在腹腔镜下顺利完成,平均手术时间105min,平均出血50ml,平均住院时间7d,术后2例发生切口感染,无其他严重并发症发生。OG组平均手术时间118min,平均出血108ml,平均住院时间12d,其中7例发生切口感染,3例发生胃排空障碍,并且有1例发生吻合口瘘,1例发生术后肠梗阻。两组间术中出血和住院时间差异均有统计学意义（P〈0．05）。结论腹腔镜下胃手术是一种安全适用的微创外科手术,具有手术时间短、出血少、创伤小、住院时间短的优点。     

Reduced blood loss by aprotinin in thoracic surgical operations associated with high risk of bleeding. A placebo-controlled, randomized phase IV study.

OBJECTIVE: Although the blood-saving effect of aprotinin has been well documented in cardiac surgery and lung transplantation, its use in lung surgery has received less attention. We present our experience with the intraoperative application of aprotinin in lung resections with a predicted high risk of bleeding. METHODS: Thirty-eight patients undergoing major thoracic surgical procedures were randomized into treatment and placebo groups. The treatment group (n=18) received a bolus of 2 x 10(6) kallikrein inhibitor units (KIU) of aprotinin followed by 5 x 10(5) KIU/h during surgery. The placebo group (n=20) received an isotonic saline infusion instead. RESULTS: There was no significant difference between the groups concerning diagnosis, co-morbidity, age, sex, height, and weight. The mean intraoperative blood loss in the treatment group was significantly reduced (342 vs. 808 ml, P<0024), postoperative blood loss was also reduced (623 vs. 1282 ml, P<0.0007) and the need for blood transfusion was less (14 vs. 60, n.s.). No severe side effects of aprotinin were registered. Re-thoracotomy was necessary in two patients of the placebo group because of postoperative bleeding. CONCLUSION: Aprotinin reduces the perioperative blood loss and the need for blood transfusion in thoracic surgical procedures in patients with an increased risk of bleeding.     

Intensive geriatric rehabilitation of hip fracture patients

We determined the effect of geriatric rehabilitation of hip fracture patients on mortality, length of hospital stay, and functional recovery. In a randomized, controlled intervention study, 243 community dwelling hip fracture patients over 64 years of age were randomly assigned to 2 rehabilitation groups. The intervention group (n = 120) was referred to a geriatric ward for team rehabilitation, and the controls (n = 123) to local hospital wards for standard care. The median length of total hospital stay after a hip fracture operation was 34 (95% CI 28-38) days in the intervention group and 42 (95% CI 35-48) days in the control group (p = 0.05). The intervention group recovered instrumental activities of daily living faster (p = 0.05). Direct costs of medical care during the first year did not differ remarkably.     

腹腔镜与开腹肝血管瘤切除术对患者术后恢复的影响分析

目的探讨腹腔镜肝血管瘤切除术与开腹手术对患者术后恢复疗效。方法将56例肝血管瘤患者随机分为腹腔镜组和开腹组,每组28例。比较两组患者术中资料和术后恢复情况。应用SPSS 20.0软件包进行数据处理,手术时间、术中出血量、术中输血量、切口长度、ALT水平、AST水平、术后输血量、术后引流量及住院天数等计量资料以(x珋±s)表示,采用t检验;并发症发生率等计数资料采用χ2检验或Fisher检验。P0.05为差异具有统计学意义。结果腹腔镜组患者切口长度(6.4±0.6)cm、术中流血量(132.3±25.8)ml和术中输血量(104.3±15.6)ml与开腹组[分别为(24.5±4.7)cm、(245.6±36.2)ml、(211.5±22.8)ml]比较差异具有统计学意义(t=20.214,13.487,20.533,P0.01)。腹腔镜组患者术后输血量(402.5±45.3)ml、引流量(244.6±35.2)ml、住院天数(9.4±1.5)d和并发症发生率(14.3%)显著低于开腹组[(588.6±67.1)ml、(335.1±38.1)ml、(12.8±2.1)d、39.3%]差异具有统计学意义(t=12.163,t=9.232,t=6.971,P0.01)。腹腔镜组术后并发症4例(14.3%)明显低于开腹组11例(39.3%),差异具有统计学意义(χ2=4.462,P0.05)。结论腹腔镜肝血管瘤切除术治疗肝血管瘤术中损伤较小、患者术后肝功能和其他生理指标恢复更快具有临床应用价值。     

Short-term outcomes of robotic-assisted right colectomy compared with laparoscopic surgery: A systematic review and meta-analysis

To assess the clinical efficacy and safety of robotic-assisted right colectomy (RRC) with conventional laparoscopic right colectomy (LRC) by performing a systematic review and meta-analysis of the published studies. All published literature for comparative studies reporting preoperative outcomes of RRC and LRC were searched. We searched the databases included Cochrane Library of Clinical Comparative Trials, MEDLINE, Embase, Web of Science and Chinese Biomedical Database (CBM) from 1973 to 2018. The censor date was up to January 2018. Operative time, estimated blood loss, length of hospital stay, conversion rates to open surgery, postoperative complications, and related outcomes were evaluated. All calculations and statistical tests were performed using Stata 12.0 software. A total of 7769 patients with colon cancer enrolled in 13 trials were divided into a study group (n = 674) and a control group (n = 7095). Meta-analysis suggested significantly greater length of hospital stay in the LRC group [MD = ?0.85; 95% CI: ?1.07 to ?0.63; P < 0.00001]. Robotic surgery was also associated with a significantly lower complication rate [OR = 0.73; 95% CI: 0.52 to 1.01; P = 0.05]. There were statistically significant differences between the groups in estimated blood loss [MD = ?16.89; 95% CI: ?24.80 to ?8.98; P < 0.00001] and the rate of intraoperative conversion to open surgery [OR = 0.34, 95% CI: 0.15 to 0.75; P = 0.008)], but these differences were not clinically relevant. The recovery of bowel function in two groups is no significant differences [MD = ?0.58, 95% CI: ?0.96 to ?0.20, P = 0.0008]. However, operation times [MD = 43.61, 95% CI: 39.11 to 48.10, P < 0.00001] were longer for RRC than for LRC. Compared to LRC, RRC was associated with reduced estimated blood loss, reduced postoperative complications, longer operation times. Recovery of bowel function and other perioperative outcomes were equivalent between the two surgeries.     

Aprotinin reduces blood loss in off-pump coronary artery bypass (OPCAB) surgery.

OBJECTIVE: Effects of aprotinin in off-pump coronary artery bypass (OPCAB) surgery have not yet been described. This study analyses hemostasiologic changes and potential benefit in OPCAB patients treated with aprotinin. METHODS: In a prospective, double-blind, randomized study 47 patients undergoing OPCAB surgery were investigated. Patients received either aprotinin (2 x 10(6) KIU loading dose and 0.5 x 10(6) KIU/h during surgery, n=22) or saline solution (control, n=25). Activated clotting time was adjusted to a target of 250 s intraoperatively. Blood samples were taken up to 18h postoperatively: complete hematologic and hemostasiologic parameters including fibrinopeptide A (FPA) and D-dimer in a subgroup of 31 patients were analyzed. Blood loss, blood transfusion and other clinical data were collected. RESULTS: Both groups showed comparable demographic and intraoperative variables. Forty-one (87%) patients of the whole study group received aspirin within 7 days prior to surgery. Number of grafts per patient were comparable (2.9+/-1.0 [mean+/-SD] in the aprotinin group and 2.8+/-1.2 in control, P=0.83). Blood loss during the first 18 h in intensive care unit was significantly reduced in patients treated with aprotinin (median [25th-75th percentiles]: 500 [395-755] ml vs. 930 [800-1170] ml, P<0.001). Postoperatively only two patients (10%) in the aprotinin group received packed red blood cells, whereas eight (35%) in the control group (P=0.07). Perioperatively FPA levels reflecting thrombin generation were elevated in both groups. The increase in D-dimer levels after surgery was significantly inhibited in the aprotinin group (P<0.001). Early clinical outcome was similar in both groups. CONCLUSIONS: Aprotinin significantly reduces blood loss in patients undergoing OPCAB surgery. Inhibition of enhanced fibrinolysis can be observed. FPA generation during and after OPCAB surgery seems not to be influenced by aprotinin.     

Leukocyte reduction during orthotopic liver transplantation and postoperative outcome: a pilot study

STUDY OBJECTIVE: To investigate the effect of intraoperative leukocyte reduction of administered blood products on the incidence of acute cellular rejection and postoperative patient outcome. DESIGN: Prospective, nonrandomized, historical control study. SETTING: Academic tertiary medical center. PATIENTS: The study group (Group 1) consisted of 30 consecutive adult patients with end-stage liver disease scheduled to undergo orthotopic liver transplantation (OLT) between 1998 and 2000. The historical control group (Group 2) consisted of 30 adult patients with end-stage liver disease matched to study group patients as closely as possible for age, gender, and etiology of liver disease who underwent OLT between 1995 and 1999. INTERVENTIONS: Group 1 patients had all intraoperative allogeneic and cell salvaged blood products leukocyte reduced before administration. Group 2 patients underwent OLT without leukocyte filtration of any administered blood products. MEASUREMENTS: Demographic data were collected for both patient groups and included age, gender, etiology of liver disease, and both intraoperative and postoperative immunosuppression. Demographic allograft donor data for both patient groups were collected and included age, gender, use of vasopressors during procurement, and cold and warm donor organ ischemic times. Outcome variables measured included incidence of acute cellular rejection, length of intensive care unit (ICU) and length of hospital stay, incidence of both graft loss and retransplantation, and mortality. MAIN RESULTS: The incidence of acute cellular rejection was 40% in Group 1 and 66.7% in Group 2 (p = 0.037). Length of ICU stay was 3.0 (2.0, 5.0) days in Group 1 and 4.0 (3.0, 6.0) days in Group 2 (p = 0.16). Length of hospital stay was 14.0 (11.0, 18.0) days in Group 1 and 18.0 (14.0, 27.0) days in Group 2 (p = 0.035). One allograft was lost in Group 2 because of primary nonfunction requiring retransplantation (p = 0.31), and three postoperative deaths occurred in Group 1 as a result of multisystem organ failure (p = 0.08). CONCLUSIONS: Coincident with leukocyte reduction of all administered blood products during OLT, an improved outcome was observed in Group 1 patients as demonstrated by both a decreased incidence of acute cellular rejection and length of hospital stay.     

Impacto da hipotensão e perda sanguínea intraoperatórias na lesão renal aguda após cirurgia de pâncreas

PurposeThis study aimed to investigate factors associated with postoperative Acute Kidney Injury (AKI) focusing on intraoperative hypotension and blood loss volume.MethodsThis was a retrospective cohort study of patients undergoing pancreas surgery between January 2013 and December 2018. The primary outcome was AKI within 7 days after surgery and the secondary outcome was the length of hospital stay. Multivariate analysis was used to determine explanatory factors associated with AKI; the interaction between the integrated value of hypotension and blood loss volume was evaluated. The differences in length of hospital stay were compared using the Mann‐Whitney U‐test.ResultsOf 274 patients, 22 patients had experienced AKI. The cube root of the area under intraoperative mean arterial pressure of < 65 mmHg (Odds Ratio = 1.21; 95% Confidence Interval 1.01–1.45; p = 0.038) and blood loss volume of > 500 mL (Odds Ratio = 3.81; 95% Confidence Interval 1.51–9.58; p = 0.005) were independently associated with acute kidney injury. The interaction between mean arterial hypotension and the blood loss volume in relation to acute kidney injury indicated that the model was significant (p < 0.0001) with an interaction effect (p = 0.0003). AKI was not significantly related with the length of hospital stay (19 vs. 28 days, p = 0.09).ConclusionThe area under intraoperative hypotension and blood loss volume of > 500 mL was associated with postoperative AKI. However, if the mean arterial pressure is maintained even in patients with large blood loss volume, the risk of developing postoperative AKI is comparable with that in patients with small blood loss volume.     

Aprotinin reduces postoperative bleeding and the need for blood products in thoracic surgery: results of a randomized double-blind study

Objective: Bleeding complications have been a major concern in certain thoracic surgery operations, especially decortication and pulmonary resection for inflammatory pulmonary infection. Prevention of plasminogen activation and fibrinolysis by aprotinin administration has been shown to reduce perioperative bleeding during operations associated with high blood consumption. Methods: Use of blood products (packed red cells, whole blood), chest tube drainage, analgesic requirement, chest tube duration for the patients undergoing major thoracic operations were recorded. In a double blind randomized fashion, patients were assigned to two groups receiving aprotinin (n=51) at a loading dose of 10⁶ kallikrein inhibitory units (KIU) followed by an infusion of the same dose during chest closure or receiving placebo (n=52). On a daily basis, red-cell percentages of total fluid from drainage bottles were recorded and using the blood hematocrit level of the patient of the day before, the corrected value for the patient's blood volume equivalent of daily drainage was calculated. Results: There was a significant reduction in perioperative use of donor blood (0.98±0.92 vs. 0.45±0.32 unit; P=0.0026), and total chest tube drainage (corrected value for the corresponding blood volume) (28.2±36.9 vs. 76.9±53.3 ml, P=0.0004) (mean±standard deviation) in the aprotinin group. However, aprotinin did not reduce postoperative transfusion or decrease in hematocrit level due to thoracic operations. In high transfusion-risk thoracic surgery patients (patients who underwent decortication, pulmonary resection for inflammatory lung disease and chest wall resection), the perioperative transfusion was only 0.50±1.08 units in aprotinin group, compared with 1.94±0.52 units in control group (P=0.003). Postoperative transfusion was also reduced in aprotinin administrated group (0.53±0.56 vs. 1.38±0.97 units; P=0.02). The mean total blood loss was decreased to nearly one third of the blood loss of the control group (41±28 ml vs. 121±68 ml; P=0.001). Conclusion: Aprotinin significantly reduced perioperative transfusion requirement and postoperative bleeding during major thoracic operations. Aprotinin decreased perioperative transfusion needs. Moreover, patients who were at risk of greater blood loss during and after certain thoracic operations had a greater potential to benefit from prophylactic perioperative aprotinin treatment.     

Effects of high-dose aprotinin on blood loss, platelet function, fibrinolysis, complement, and renal function after cardiopulmonary bypass.

The use of aprotinin to reduce blood loss after cardiopulmonary bypass is under debate. Concern has been raised about the renal effects of aprotinin. We administered a mean aprotinin dose of 4.2 x 10(6) kallikrein-inhibiting units to 13 patients with coronary disease undergoing cardiopulmonary bypass for 74 +/- 5 minutes (mean +/- standard error of the mean); 13 comparable patients having cardiopulmonary bypass served as control subjects, and all were studied postoperatively for 24 hours. Aprotinin reduced postoperative blood loss by 50% (p = 0.0082). Two of the 13 patients who received aprotinin needed one red cell unit each versus a total of 18 units in eight of 13 control patients (p = 0.0096). Blood pressure, hemoglobin value and serum protein concentration were higher after operation in the aprotinin group (p less than 0.05 to p less than 0.01). Platelet counts did not differ, but plasma thromboxane was lower in aprotinin recipients (p less than 0.001). In control patients fibrinogen degradation products (D dimer) doubled, and alpha 2-antiplasmin activity was halved during and after cardiopulmonary bypass (p less than 0.01 to p less than 0.001), whereas aprotinin patients showed no changes. The complement breakdown products C4a, C3a, and C3dg as well as C9 neoantigen increased from prebypass baseline in both groups (p less than 0.001); the increment of C3a and C3dg was greater in the aprotinin than in the control patients (p less than 0.001). Serum electrolytes, osmolality, and creatinine remained normal in both groups of patients. Creatinine clearance was normal or above normal and virtually identical in both groups. Osmolar clearance and fractional sodium excretion were higher in the aprotinin group than in the control group shortly after cardiopulmonary bypass (p less than 0.05 to p less than 0.01); renal function was unremarkable the next morning. No adverse clinical effects attributable to aprotinin were seen. In summary, aprotinin offers advantages for cardiopulmonary bypass.     

Does aprotinin reduce blood loss in total hip arthroplasty?

This prospective randomized study examined the effects of aprotinin during total hip arthroplasty (THA). Fifty patients who were enrolled in the study received aprotinin or normal saline. Mean intraoperative blood loss was reduced from 1496 mL in the control group to 1073 mL in the aprotinin group. The mean transfusion unit was 1.56 in the aprotinin group and 3.8 in the control group.     

常规器械单孔腹腔镜妇科和外科疾病联合手术46例

目的探讨常规器械单孔腹腔镜妇科和外科疾病联合手术的应用价值。 方法回顾性分析2014年1月至2017年11月,采用常规器械单孔腹腔镜妇科和外科联合手术46例(观察组,其中单孔腹腔镜胆囊和卵巢囊肿联合手术32例、胆囊和子宫联合手术6例、胆囊和输卵管积水联合手术3例、阑尾和卵巢囊肿联合手术4例、胆囊和输卵管吻合联合手术1例),与同期单孔腹腔镜相应妇科手术46例进行对比分析(对照组)。 结果观察组：手术时间50 ～ 240 min,平均(119.03 ± 41.17)min;术中出血量10l～450 ml,平均(46.33 ± 17.28)ml,术后住院时间3 ～ 7 d,平均(3.98 ± 0.75)d。对照组：手术时间50 ～ 210 min,平均(106.39 ± 32.32)min;术中出血量20 ～ 300 ml,平均(45.65 ± 16.20)ml,术后住院时间3 ～ 5 d,平均(3.80 ± 0.02)d。两组的手术时间、术中出血量、术后肠道恢复时间、术后住院时间比较,差异无统计学意义(P> 0.05)。 结论常规器械单孔腹腔镜妇科和外科多个疾病联合手术能降低医疗成本,患者腹部切口更美观。