Optimal dose of aprotinin for neuroprotection and renal function in a piglet survival model
Optimal dose of aprotinin for neuroprotection and renal function in a piglet survival model
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DOI：
10.1016/j.jtcvs.2008.06.049
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发表时间：
2009-06-01
影响因子：
6
通讯作者：
Jonas, Richard A.
中科院分区：
文献类型：
--
作者：
Iwata, Yusuke;Okamura, Toru;Jonas, Richard A.
目的：抑肽酶在减少心肺转流术后失血量方面的疗效已得到公认，尽管其神经保护作用尚不为人所知。此外，有争议的最佳剂量和可能的肾脏complications.Methods：54只小猪被随机分配到3个心肺转流组之一，旨在进行术后脑和肾功能不全的风险：循环停在25摄氏度和超低流量旁路（10毫升）。kg（-1）。25摄氏度或34摄氏度时最小（-1））。将动物随机分配至以下组：对照组（无抑肽酶）、低剂量组（30，000 KIU/kg，仅预充）、标准全剂量组（30，000 KIU/kg静脉推注，预充加10，000 KIU/kg输注）和双倍全剂量组。通过近红外光谱监测组织氧合指数。神经功能和组织学评分和肌酐和血尿素氮值是interests.Results的结果：抑肽酶显着改善术后第1天的神经功能评分后，超低流量旁路在25摄氏度或34摄氏度（P <0.01），但不是在低温停循环（P = 0.57）。线性回归显示了很强的剂量-反应关系，较高的抑肽酶剂量具有最好的神经系统评分。在低流量转流期间，较高的组织氧合指数与较高的抑肽酶剂量相关（P <0.05）。抑肽酶剂量对第1天的肌酐或血尿素氮值无显著影响。低体重是高血尿素氮值的唯一预测因子（r =-0.39，P <0.01）。结论：抑肽酶可显著改善幼龄仔猪的神经功能恢复，而不损害肾功能。
Objective: The efficacy of aprotinin in reducing blood loss after cardiopulmonary bypass is well established, although its neuroprotective potential is less well known. Furthermore, there is controversy regarding optimal dosing and possible renal complications.Methods: Fifty-four piglets were randomized to one of 3 cardiopulmonary bypass groups designed to carry the risk of postoperative cerebral and renal dysfunction: circulatory arrest at 25 degrees C and ultra-low flow bypass ( 10 mL . kg(-1) . min(-1)) at either 25 degrees C or 34 degrees C. Animals were randomized to the following groups: control ( no aprotinin), low dose ( 30,000 KIU/kg into prime only), standard full dose ( 30,000 KIU/kg bolus administered intravenously into prime plus 10,000 KIU/kg infusion), and double full dose. The tissue oxygenation index was monitored by means of near-infrared spectroscopy. Neurologic functional and histologic scores and creatinine and blood urea nitrogen values were outcomes of interest.Results: Aprotinin significantly improved neurologic scores on postoperative day 1 after ultra-low-flow bypass at 25 degrees C or 34 degrees C (P < .01) but not after hypothermic circulatory arrest (P = .57). Linear regression indicated a strong dose-response relationship, with higher aprotinin doses having the best neurologic scores. During low-flow bypass, a higher tissue oxygenation index was correlated with a higher aprotinin dose (P < .05). Aprotinin dose had no significant effect on creatinine or blood urea nitrogen values on day 1. Low body weight was the only predictor of high blood urea nitrogen values (r = -0.39, P < .01).Conclusion: Aprotinin significantly improves neurologic recovery without compromising renal function in the young piglet.