ROLE OF UROKINASE AND TISSUE ACTIVATOR IN SUSTAINING BLEEDING AND THE MANAGEMENT THEREOF WITH EACA AND AMCA
ROLE OF UROKINASE AND TISSUE ACTIVATOR IN SUSTAINING BLEEDING AND THE MANAGEMENT THEREOF WITH EACA AND AMCA
复制标题
尿激酶和组织激活剂在持续出血中的作用及其使用 EACA 和 AMCA 的管理
DOI：
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发表时间：
1968
影响因子：
5.2
通讯作者：
B. Melander
中科院分区：
文献类型：
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作者：
L. Andersson;Inga Marie Nilsoon;S. Colleen;J. B. Granstrand;B. Melander
多年来，我们一直对抗纤溶药物治疗纤溶性出血的效果感兴趣。我们研究的第一种药物是氨基己酸（EACA，ε-氨基己酸）。最近，我们将注意力集中在氨甲环酸（AMCA，反式对氨基甲基环己烷甲酸）（图 1）上。大多数进行的研究都涉及循环血液中纤溶活性增加的情况。这些出血通常是大量的、弥漫性的、难以止血，从而危及生命。因此，必须高度重视它们。幸运的是，这些情况很少见。更频繁。纤溶系统激活剂通常存在于各个器官系统中，维持局部出血。这对于泌尿道尤其明显。许多作者，例如麦克尼科尔等人。 （1961a）；萨克等人。 （1962）； Ladehoff 和 Otte (1963) 以及我们在马尔默和隆德的研究小组已经证明，尿液中的纤溶酶原激活剂尿激酶可以溶解血栓并维持尿道自发出血和术后出血。在许多其他器官系统中，正常存在的纤溶酶原激活剂似乎会持续出血，并且这种出血可以通过蛋白酶抑制剂成功治疗。这适用于子宫、结肠、胃、牙槽和其他器官。最有可能的是，这些正常存在的纤溶系统激活剂不会引起出血，而是持续出血，因为它们溶解了密封开放血管的小凝块，这对于伤口愈合的第一阶段至关重要。在我们的研究中，我们使用 EACA 作为参考，并且自从我们决定与 AMCA 一起进行新型研究以来，我们还研究了 EACA 的排泄模式以及血液和组织水平，尽管文献仅包含关于 EACA 尿排泄的零散观察。
For a number of years we have been interested in the effect of antifibrinolytic agents in the treatment of fibrinolytic hemorrhages. The first drug we studied was aminocaproic acid (EACA, epsilonaminocaproic acid). More recently we have devoted our interest to tranexamic acid (AMCA, trans p-aminomethyl cyclohexane carboxylic acid) (FIGURE 1.) Most of the investigations performed have dealt with conditions where an increased fibrinolytic activity occurs in the circulating blood. These hemorrhages are often copious, diffuse, difficult to arrest, and thereby life-threatening. ACcordingly, great importance must be attached to them. These conditions are, fortunately, rare. More frequently. activators of the fibrinolytic system, which normally are present in the various organ systems, sustain local bleedings. This is especially conspicuous for the urinary tract. Many authors, e.g. McNicol et al. (1961a); Sack et al. (1962); Ladehoff and Otte (1963), as well as our groups in Malmo and Lund, have shown that the plasminogen activator of the urine, urokinase, dissolves blood clots and sustains spontaneous as well as postoperative bleeding in the urinary tract. In many other organ systems normally-occurring plasminogen activators appear to sustain hemorrhage, and this hemorrhage can be successfully treated by protease inhibitors. This applies to the uterus, the colon, the stomach, the tooth-sockets, and other organs. Most probably these normallyoccurring activators of the fibrinolytic system do not induce hemorrhage, but rather, sustain bleedings, since they dissolve the small clots that seal opened vessels and that are essential for the first stage of wound healing. In our studies we have used EACA as reference, and since we decided to run a new type of study with AMCA, we have also studied excretion patterns and blood and tissue levels for EACA even though the literature contains only scattered observations on EACA with regard to its urinary excretion.