摘要
目的探讨氨基己酸对体外循环(CPB)下心脏直视手术患者纤溶系统的影响。方法40例心脏直视手术患者随机分为二组:氨基己酸组(A组)和对照组(B组),每组20例。A组在CPB 预充液中单次加入氨基己酸200 mg/kg,B组在CPB预充液中加入等量生理盐水。分别于切皮前即刻(T0)、CPB 8min(T1)、30min(T2)、鱼精蛋白中和肝素后10min(T3)、术后2 h(T4)时采集静脉血,测定血浆组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制剂(PAI)、纤溶酶(Plm)活性及D-二聚体(D- dimer)浓度,同时记录术后24 h内出血量及输库血量。结果与T0比较,B组血浆t-PA、t-PA/PAI活性在T1-3、Plm活性在T1,2、D-dimer浓度在T1-4时升高(P<0.05或0.01)。与B组比较,A组血浆t-PA活性、t-PA/PAI在T1-3、Plm活性在,T1,3、D-dimer浓度在T2-4时降低(P<0.05或0.01)。术后24 h出血量及输库血量A组少于B组(P<0.05)。结论CPB可激活纤溶系统;氨基己酸可抑制CPB引起的纤溶系统激活,减少术后出血和输库血量。
Objective To investigate the dynamic changes in the fibrinolytic system during and after open heart surgery performed with cardiopulmonary bypass (CPB) and the effect of epsilon-aminocaproic acid (EACA) on fibrinolysis, postoperative blood loss and transfusion requirements.Methods Forty patients (24 males, 16 females) aged 17-43 yr undergoing valve replacement with CPB were randomized to receive EACA 200 mg·kg-1 (group A) or normal saline (group B) added to the priming solution. The patients were premedicated with intramuscular morphine 0.2 mg·kg-1 and scopolamine 0.3 mg. Anesthesia was induced with midazolam 0.2 mg · kg, fentanyl 10 μg·kg-1 and vecuronium 0.1 mg·kg-1 and maintained with isoflurane inhalation and intermittent i.v. boluses of fentanyl and vecuronium. The patients were mechanically ventilated (VT = 10 ml·kg-1 , RR = 10-12 bpm, I:E = 1:2) after tracheal intubation. Blood samples were taken before skin incision (baseline) , 8 and 30 min on CPB, 10 min after protamine administration and 2 h after operation for determination of tissue type plasminogen activator (t-PA) activity, plasminogen activator inhibitor (PAI) activity, plasmin (Plm) activity and D-dimer. The amount of blood drained from chest and bank blood infused within 24 h after operation were recorded.Results (1) Group B (control group): PAI activity was maintained stable perioperatively. The t-PA activity and t-PA/PAI ratio increased significantly during operation but returned to the baseline value 2 h after operation. D-dimer level also significantly increased during and after operation. The Plm activity increased significantly at 8h on CPB and 10 min after protamine administration compared to the baseline value. (2) The t-PA activity and t-PA /PAI ratio were significantly lower in group A than in group B. The D-dimer level and Plm activity were also significantly lower in group A than in group B during and after operation. The amount of blood loss and bank blood infused within 24 h after operation was 40% and 37% less than that in group B.Conclusion Fibrinolytic system is activated during CPB as shown by the increase in plasminogen and t-PA/PAI ratio. EACA is effective in reducing postoperative blood loss and blood transfusion through inhibition of the activation of fibrinolytic system.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2005年第4期255-257,共3页
Chinese Journal of Anesthesiology
关键词
氨基己酸
体外循环
心脏直视手术
纤溶系统
Aminocaproic acids
Cardiac surgical procedures
Cardiopulmonary bypass
Fibrinolysis
