Фгбну «Российский научный центр хирургии им. акад. б.в. Петровского», Москва, Россия Цель исследования-провести сравнительную оценку эффективности аминокапроновой (εАКК) и транексамовой (тК) кислот в снижении объемов отделяемого по дренажам после различных кардиохирургических операций. Материал и методы. Ретроспективно проанализированы 1633 истории болезни кардиохирургических пациентов, оперированных в Фгбну «РнцХ им. акад. б.в. Петровского» в период 2012-2014 гг. в зависимости от используемого во время операции аналога лизина больные были разделены на две группы: 1-я группа (n=927) с тК (ФгуП «Московский эндокринный завод», Россия), 2-я группа (n=706) с εАКК («Мосхимфармпрепараты», Россия). оба препарата вводили в виде пролонгированной инфузии в дозе 10 мг/кг/ч для тК и 20 г для εАКК. у всех пациентов оценивали объем геморрагического отделяемого по дренажам через 6 и 12 ч после операции. Результаты. отмечен одинаковый гемостатический эффект интраоперационного пролонгированного введения тК в дозе 10 мг/кг/ч или εАКК в дозе 20 г. одинаковая гемостатическая эффективность тК и εАКК отмечалась и при различных условиях перфузии-длительность и температура искусственного кровообращения (иК), а также при различных видах операций на сердце и аорте в условиях иК. Количество рестернотомий, выполненных в связи с кровотечениями, в группе с тК достоверно не отличалось от такового у больных группы с εАКК.

This study examined dynamics for blood gas, parameters of acid-base equilibration, water-and-electrolyte balance, glucose, hemocoagulation, and blood rheology at surgery for aortic arch and thoracoabdominal aneurysm during profound hypothermia and circulatory arrest. Frequency for development of homeostatic disorders was related to the temperature (r = -0.71; P < 0.05), and to the duration of circulatory arrest period (r - 0.77; P <0.05). Also, it established the dependencies from duration of cooling time (r = 0.59; P < 0.05), and from warming time when temperature has attained more than 28±C (r = -0.65; P < 0.05). It was shown that long hypoxia and reperfusion disorder stipulated the decrease of utilization for main metabolites, the increase of oxygen failure in tissues, the increase of the permeability of cells membranes, and the increase of blood viscosity and disseminated intravascular coagulation (DIC), which are the main reasons for homeostasis disorders during the same surgery. In the period from the start to the end of the second extracorporeal circulation, there exists the heaviest probability for hypoxic failure in tissues and thrombohemorrhagic complications. For aortic aneurysm surgery with circulatory arrest and profound hypothermia, the adequacy for the correction of homeostatic disorders is expressed only in complex therapy of hypoxical and thrombohemorrhagic complications that enable one to execute simultaneous reduction of the tissue's oxygen deficit and failures of hemocoagulation and blood rheology.

The chemotactic properties of cyclophilin A are well-known. There exists however a poor level of understanding regarding the hemostatic effects of this protein. Herein it is shown that recombinant human cyclophilin A (rhСyA), in contrast to the granulocyte colony-stimulating factor, is capable of inhibiting in vitro the formation of a fibrin clot, thereby violating the spatial dynamics of clot growth; this effect is transient and dose-independent. Furthermore, the hypothesis that the conformational changes in the thrombin-rhCyA complex may mediate the anticoagulant effect of rhCyA on the autowave processes of blood clotting is postulated. KEYWORDS recombinant human cyclophilin A; spatial dynamics of clot growth; anticoagulant activity. ABBREVIATIONS rhCyA -recombinant human cyclophilin A; DCG -delay of clot growth, min; IGR -initial growth rate, min; SSGR -steady-state growth rate, min; CS-30 -clot size after 30-minute growth, µm; CD -the clot density; G-CSF -granulocyte colony-stimulating factor.

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The chemotactic properties of cyclophilin A are well-known. There exists however a poor level of understanding regarding the hemostatic effects of this protein. Herein it is shown that recombinant human cyclophilin A (rhСyA), in contrast to the granulocyte colony-stimulating factor, is capable of inhibitingin vitrothe formation of a fibrin clot, thereby violating the spatial dynamics of clot growth; this effect is transient and dose-independent. Furthermore, the hypothesis that the conformational changes in the thrombin–rhCyA complex may mediate the anticoagulant effect of rhCyA on the autowave processes of blood clotting is postulated.