摘要
【目的】通过血栓弹力图（TEG）以及凝血三项指标（PT,aPTT,Fb）对凝血功能的评估和对失血、输血量的统计,比较氨甲环酸复合血凝酶和抑肽酶在换瓣病人中的血液保护效果。【方法】选择换瓣手术的病人（ASAⅡ-Ⅲ级）20例,随机分为两组：A组为使用血凝酶加氨甲环酸组;B组为使用抑肽酶组。分别在转机前（T1）,肝素中和后10 min（T2）,肝素中和后3 h（T3）,颈内静脉抽血进行TEG和凝血三项的检查。记录体外循环结束到手术结束的时间;病人回到ICU后,观察记录不同时间病人的胸腔引流量和输血量（RBC＆FFP）,第一次伤口换药时,对渗血超过1 cm^2纱布计数,对伤口渗血情况进行评分。比较两组血液的保护效果和相关的费用。【结果】除了T2的PT、Fb以及T3的PT在两组之间存在明显的差异（P〈0.05）,其他凝血功能检查结果、手术室停留时间以及渗血纱布计数均无统计学上差异（P〉0.05）,输血量和出血量也无统计学差别（P〉0.05）,而A组的药物费用明显少于B组,有统计学差异（P=0.002）。【结论】在心脏瓣膜置换术中,氨甲环酸复合血凝酶,能达到与抑肽酶相似的血液保护效果,同样减少了术后出血和输血量;但前者的药物费用明显少于后者。
[Objective] To compare the blood conservation effects of tranexarnic acid combining with hernocoagulase with those of aprotinin in cardiac valve surgery by analyzing blood clotting function , the result of prothrombin time （PT）, activated partial thromboplastin time （aPTT）, fibrinogen （Fb）, thromboelastogram （TEG）, drainage volume of thoracic and the blood products transfused. [Methods] Twenty patients （ASA Ⅱ- Ⅲ） elected for cardiac valve surgery were randomly divided into two groups： Group A （n= 10） received tranexamic acid （300mg load, 50mg/h infusion） combining hemocoagulase 2U; Group B （n= 10） received aprotinin （2 million KIU 2 load, 0.5 million infusion） combining saline. We have recorded the different values of laboratory examination at three times with blood samples drawn from internal jugular vein. We also have recorded the drainage volume of thoracic and the blood products （RBC ＆ FFP） transfused when the patients was stay in the ICU. We regarded the period in operating room from CPB-end to the end of skin closure as the stay in operating room, and counted numbers of bloody gauze layer which blood-infiltrated plaque was over 1cm^2, which was regarded as a measurement of blood loss from the wound. The cost of medical and blood products transfused were compared between two groups. [Results]Most of the laboratory values we checked had no significantly difference between two groups（ P 〉0.05）, excluded PT and Fb at 10 rain and PT at 3h after the heparin neutralized （ P〈0.05）. There were no significantly difference in drainage of thoracic （ P=0.2） and blood products transfused between two groups（ P=0.7）. The treatment with combination of tranexamic acid and hemocoagulase significantly reduced medical cost （ P〈0.05）.[Conclusion] The combination of tranexamic acid and hemocoagulase has the same effect as aproinin 3 million KIU in blood conservation of cardiac valve surgery, but the former has less cost .
出处
《医学临床研究》
CAS
2007年第12期2030-2034,共5页
Journal of Clinical Research
关键词
心脏瓣膜假体植入
氨甲环酸
凝血酶
抑肽酶
heart valve prosthesis implantation
tranexamic acid
thrombin
aprotinin
