Blood protective effect of aprotinin during liver cancer resection / 中华麻醉学杂志

ABSTRACT

Objective Aprotinin, a serine proteinase inhibitor, has been reported to reduce blood loss significantly in patients undergoing cardiac surgery with CPB, heart and liver transplantation. The aim of this study was to evaluate the effect of aprotinin on intraoperative blood loss, transfusion requirement and blood coagulation during liver cancer resection.Methods Eighty-two ASA Ⅰ -Ⅲ patients ( 51 male, 31 female ) aged 33-65 yr undergoing liver cancer resection ( 61 partial hepatectomy, 21 extirpation of liver cancer) were studied. The patients were randomly divided into 2 groups aprotinin group received a bolus of aprotinin 1 112 EPU after induction of anesthesia, followed by continuous aprotinin infusion at 278 EPU?h-1 until 2 h after operation ( n = 40); control group received normal saline instead of aprotinin ( n = 42) . The patients were premedicated with sodium luminal, droperidol-fentanyl and atropine. Anesthesia was induced with midazolam 2 mg, thiopental 5 mg?kg-1 and succinylcholine 1.5 mg? kg-1 . After tracheal intubation the patient was mechanically ventilated (VT = 8-12 ml?kg-1 ) and PaCO2 was maintained at about 35 mm Hg, Anesthesia was maintained with N2O/O2 , fentanyl and vecuroniurn. Venous blood samples were taken before induction of anesthesia (baseline) , 0.5 h, 2 h and 4 h after skin incision and 6 h and 12 h after operation for routine blood tests, thromboelastography ( TEG), and determination of activated partial thromboplastin time (APTT), thromboplastin time (TT) prothrombin time (PT) and plasma fibrinogen concentration (Fig) . Intraoperative blood loss and amount of blood transfused were recorded. Results The preoperative hypercoagulable state was ameliorated and coagulation was maintained within the normal range in aprotinin group; while in control group the hypercoagulable state was aggravated during operation and at the end of operation it changed to hypocoagulable state. The intraoperative blood loss and amount of blood infused were significantly less in aprotinin group than in control group. Conclusion The use of aprotinin during liver cancer resection results in reduction in intraoperative blood loss and less transfusion requirement.