The Effect of Coagulation Protection with Combination of Epsilon Aminocaproic Acid and Plasma Saver in Open-heart Surgery

研究Epsilon Aminocaproic Acid合併Plasma Saver對開心手術凝血系統之保護作用

劉玉成(Yu-Cheng Liu) ； 蔡宗博(Tsung-Po Tsai)

《Acta Anaesthesiologica Sinica》 36卷3期 (1998/09) Pp. 149-154

摘要

Background: Bleeding remains a major complieation and a major determinant in the prognosis of open-heart surgery. Coagulopathy related to cardiopulmonary hypass (CPB) seems to be the culprit. Since homologous blood transfusion in many occasions is not only responsible for mobidity and mortality but also increases medical costs. Therefore, the application of autologous blood transfusion including components such as PRBC, FFP and platelets concentrate is inevitable and comes in its stead. To reduce the use of homologous plasma and platelets transfusion in open-heart surgery, we designed a study to utilize the combination of autologous platelet rich plasma (PRP) and epsilon aminocaproic acid (EACA) to evaluate its effeets on blood loss and blood component transfusion in open-heart patients. Methods: Sixty patients who received elective cardiac surgery were randomly divided into 3 groups: 1. Control group; 2. EACA group (150 mg/kg, iv before CPB); 3. PRP-EACA group (PRP 10 ml/kg harvested with a plasma saver followed by iv EACA 150 mg/kg). Anesthesia was uniform in all patients. Coagulation profile was evaluated by thromboelastography (TEG) during the operation. Blood loss during operation and the amount of drainage from the chest tubes in the postoperative period were recorded and compared between groups. Results: Patients who were given EACA injection before CPB saw less blood loss perioperativly and received less transfusion of blood components. TEG analysis showed that patients who received EACA injection had a better coagulation profile and the platelet function was also better after CPB. However, no additive effect can be attained from combination of autologous PRP transfusion and EACA injection. Conclusions: With Pre-CPB EACA as protection, reduction of both blood loss and blood transfusion could be realized in open-heart surgery.

關鍵字

Cardiopulmonary bypass ； Blood transfusion, autologous ； Antifibrinolytic agent: ε-aminocaproic acid ； Thromboelastography

並列摘要

背景：開心手術病人術中及術後之失血乃是決定病人預後的重要因素，其中與開心手術中使用的體外心肺循環（CPB）所形成對血小板及凝血因子之破壞有密不可分之關聯。因此在開心手術中為了維持病人之穩定而使用大量的紅血球、血漿及血小板等血液製品乃經常發生之狀況。可是由於近年來輸血觀念的更新及進步。使我們體認到不當使用血液成品不但會增加病人暴露於各式感染之危險因子中，更會增加各種輸血反應所形成的併發症而增加了醫療照護成本的支出。因而設計本實驗以評估在併用富含血小板之自體血漿輸血及具有血小板保護作用之Epsilon aminocaproc acid（EACA）是否能減少開心手術病人之出血及用血。方法：選擇六十位接受開心手術病人，將其分成三組：1.控制組，2.EACA組（於CPB前接受EACA靜脈注射，150mg／kg）；3.PRP-EACA組（於CPB前以血漿回收機抽取10ml／kg後，再靜脈注射EACA150mg／kg），每組病人皆接受相同之麻醉方式，並使用血液凝固檢查儀（Thromboelastography）評估各組病人之凝血狀態及比較各組手術中之出血及術後24小時之胸管引流量及輸血量。結果：EACA確實能達到減少術中術後出血及使用血液製品之目的。經由Thromboelastography之分析亦可證實使用EACA之病人經CPB之後可保有較完整之凝血及血小板保護功能。但併用Plasma Saver後並看不出有更進一步的效果。結論：從本實驗中可以理解開心手術病人若作適當之防護，的確可達到減少出血輸血進而減少醫療成本之目的。經由各種方式減少病人之輸血乃全球共同努力之方向。不僅開心手術如此，各類疾病若能經由藥物之幫助或血液回收技術以減少血液製品的使用，則更能減少種種輸血併發症及更有效率的運用寶貴的血液資源。

並列關鍵字

體外心肺循環 ； 自體輸血 ； 溶纖維蛋白抑制劑：є-aminocaproic acid ； 血液凝固檢查儀