摘要
目的对比研究6-氨基己酸和抑肽酶对减少心瓣膜置换术患者术后出血的效果,观察6-氨基己酸是否可能导致患者术后血栓形成及对肾功能的影响。方法79例心瓣膜置换术患者随机分为两组,6-氨基己酸组(39例)和抑肽酶组(40例),术中分别给予6-氨基己酸和抑肽酶;记录和计算两组患者术后24h内心包纵隔引流量/体表面积、输血量;测定术前、术中主动脉开放后、术后72h外周血D-二聚体和2α-抗纤溶酶水平;测定及计算术后72h与术前血浆肌酐清除率差(ΔC rC l72),术后72 h与术前血浆肌酐清除率变化率(%ΔC rC l72);观察围手术期有无血栓及栓塞发生。结果术后24h内心包纵隔引流量/体表面积比值6-氨基己酸组明显高于抑肽酶组(P=0.019),但两组患者术后输血量差别不明显(P>0.05)。术前、术后72 h两组患者血浆D-二聚体和2α-抗纤溶酶之间的差别无统计学意义(P=0.960,0.485),术中主动脉开放后抑肽酶组患者血浆D-二聚体和2α-抗纤溶酶均高于6-氨基己酸组(P=0.001,0.000)。两组患者的ΔC rC l72差别无统计学意义(P>0.05)。两组患者术后均未观察到血栓形成或者栓塞。结论6-氨基己酸对减少心瓣膜置换术患者术后出血的有效性虽不及抑肽酶,但不增加术后输血量;剂量适当亦不会导致血栓形成和明显的肾损害。
Objective To compare the efficacy of 6-epsilon-aminocaproic acid （EACA） with aprotinin on reducing postoperative bleeding in cardiac valve replacement procedures, and to investigate its influence on the possible thromboembolism and the renal function. Methods Seventy-nine patients who underwent cardiac valve replacement were randomly divided into two groups： EACA group （n = 39） and aprotinin group （n = 40）, which were given EACA and aprotinin separately in operations. The volumes of drainage to body surface area （BSA）, blood transfusion were recorded during 24 h after operations. The concentrations of serum D-dimer and α2-antiplasmin （a2- AP） were measured before, during operation and at 72h post-operatively. The serum creatinine levels before operation and at the 72 h after operation were also measured. Results The volume ratio of drainage to BSA in EACA group was significantly higher than that in the aprotinin group at 24 h after operation （P = 0. 019）. However, there was no significant difference in the volumes of blood transfusion between two groups （P〉0. 05）. Also no statistical difference in the concentrations of D-dimer and a2-AP were found between two groups whether preoperatively or at 72h post-operatively （P= 0. 960,0. 485）, D-dimer and a2-AP of the aprotinin group were higher than those in the EACA group after aortic off-clamping （P = 0. 001,0. 000）. There was no statistically difference of △CrCl72 in both groups （P〉0. 05）. No patient with thrombosis or thromboembolism was detected in two groups.Conclusion Although the efficacy of EACA in reducing postoperative bleeding in cardiac valve replacement can not compare favorably with that of aprotinin, the blood transfusion volume would not increase when EACA is used introoperatively. Proper usage of EACA will not cause thrombosis and renal damage.
出处
《中国胸心血管外科临床杂志》
CAS
2006年第3期166-169,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
6-氨基己酸
抑肽酶
出血
心瓣膜置换术
6-epsilon-aminocaproic acid
Aprotinin
Bleeding
Cardiac valve replacement
