摘要
目的探讨氨甲环酸(tranexamic acid,TA)对体外循环(cardio-pulmonary bypass,CPB)瓣膜置换手术中出血、输血量及凝血指标的影响。方法将宁夏医科大学总医院2011年6月-2013年5月体外循环下瓣膜置换手术经纳入排除标准入选的120例病人(ASA II^III级)分为非氨甲环酸组(NTA组,n=60)和氨甲环酸组(TA组,n=60)。TA组给予氨甲环酸总量2g(200mL),于麻醉诱导后切皮前及CPB结束给予鱼精蛋白后两个时间点各给1g(100mL),一次性静脉滴注;NTA组分别于对应时间段各给予100mL的生理盐水。记录术前、CPB停机前、术毕及术后12h血红蛋白(Hb),红细胞压积(Hct);CPB前、中、后激活全血凝固时间(ACT);术前和术后的凝血四项(PT、APTT、INR、FIB);CBP时间;主动脉阻断时间;手术时间;术中血制品输入量;术后12h心包及纵膈引流量。结果两组患者一般资料的比较差异无统计学意义(P>0.05);TA组术后12h的Hb和Hct值明显高于NTA组(P<0.05),两组患者的Hb和Hct值均较术前减低(P<0.05);两组患者术后四项凝血指标(PT、APTT、INR、FIB)均较术前升高(P<0.05),但TA组术后凝血PT值、INR值较NAT组降低(P<0.05);与NTA组比较,TA组在CPB前、中、后三个时间点ACT值无明显差异(P>0.05);TA组术后12h心包及纵膈引流量较NTA组明显减少(P<0.05),且该组术中红细胞悬液及冰冻血浆的输用率较NTA组明显减少(P<0.05)。结论体外循环心脏瓣膜置换手术中应用氨甲环酸可有效减少术中、术后出血量及血液制品需求量,提示氨甲环酸有助于CPB术中的凝血因子保护。
Objective To explore the effect of tranexamic acid （ tranexamic acid, TA） on coagulation funtion, volumn of blood loss and transfusion during the perioperative period of valve replacement surgery under car- diopulmonary bypass. Methods 120 ASA II -III patients undergoing valvular replacement surgery under cardiopulmony bypass （CPB） from June of 2011 to March of 2013 were randomly divided into Not Tranexamic Acid （group NTA） and Tranexamic Acid （group TA）. The group TA （n = 60 ） were totally given 2g （100mL）of tranexamic acid. lg （100 mL） was given by intravenous drip after anesthesia induction before cutting skin and l g（100mL） was given after the heparin neutralization, group NTA（ n = 60 ） was given the same dose of saline at the same time. The value of hemoglobin, hematokrit before the operation, before CPB downtime, the end of operation and 12h after the operation were recorded ;the value of ACT before, during and after the period of CPB were recorded;Preoperative and postoperative blood coagulation four indices of PT, AFFF, INR, FIB were recorded ; and the CBP time, the aortic cross clamp time, operation time, intraoperative blood product input,pericardium and mediastinal drainage 12h after surgery were also recorded. Results No significant difference of general information was found between two groups （P 〉 0.05 ）. Compared with group NTA,the Hb and Hct value of group TA were significantly higher at the time of 12h after surgery （P 〈0.05） and the Hb and Hct value of two groups after surgery were both lower than the values before surgery （P 〈 0. 05 ）. Four coagulation indexes （ PT, ATT, INR, FIB） of two groups after surgery were higher than the val- ues before surgery （P 〈 0.05 ）. Compared with group NTA, the PT and INR value of group TA was significant- lylower （P 〈 0.05 ）. There was no significant difference of ACT value before, during and after CPB between two groups （P 〉 0.05 ）. Compared with group NTA, intraoperative blood product input, pericardium and medi- astinal drainage of group TA was significantly decreased （P 〈 0.05 ）. Conclusion Tranexamic acid used in valve replacement surgery under cardiopulmonary bypass can effectively reduce the intraoperative and postoper- ative blood loss and decrease the blood products demand. Tranexamic acid can protect the clotting factors in cardiopulmony bypass surgery.
出处
《宁夏医科大学学报》
2014年第5期519-522,共4页
Journal of Ningxia Medical University
关键词
氨甲环酸
体外循环
心脏瓣膜置换术
纤溶系统
tranexamic acid
cardiopulmonary bypass
heart valve replacement
fibrinolytic system
