氨甲环酸在婴儿先心手术中的应用  

The Efficacy of Tranexamic Acid versus Placebo in Decreasing Blood Loss in Infant Undergoing Cardiac Surgery

作　　者：王丽红[1,2] 钟慧[1] 邓萌[1] 汤顺荣[1] 张学锋[1] 周守静[3] 梁伟民[3] 

机构地区：[1]复旦大学附属儿科医院麻醉科,上海201102 [2]复旦大学附属华山医院 [3]复旦大学附属华山医院麻醉科,上海200040

出　　处：《中国临床医学》2010年第1期123-125,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:观察和评价在小婴儿先心手术中应用抗纤溶药物氨甲环酸的疗效和安全性。方法:80例1岁以内的先天性房缺或室缺患儿。随机分为两组,氨甲环酸组(组Ⅰ,n=40),氨甲环酸90mg.kg-1,分3次给予,每次30mg.kg-1,依次为术前、预充液中、体外循环后。安慰剂组(组Ⅱ,n=40)给予0.9%氯化钠液9mL.kg-1,给药方式同组Ⅰ观察项目:手术前后血细胞压积、血小板计数、常规凝血功能、D-二聚体数值;术后24h胸腔引流量、输血量、心血管重症监护室停留时间、肾功能指标、血栓形成和过敏反应。结果:氨甲环酸组术后24h出血量为(9.0±4.8)mL.kg-1,安慰剂组为(11.9±9.3)mL.kg-1(P<0.05),术后24h出血量减少24%;两组术后输血量无差别;两组术后及24h D-二聚体值均明显增加,氨甲环酸组增加程度明显小于安慰剂组(P<0.05);两组术后凝血功能指标治化部分凝血酶时间(APTT)显著延长,凝血酶原活动度(PTA)显著下降,血小板数量明显降低,组内差异显著,组间无显著差异,常规凝血指标术后24h基本恢复。术后无肾功能不全及血栓形成、过敏反应。结论:婴儿先天性房缺或室缺手术中90mg.kg-1氨甲环酸能使术后出血量减少24%。Objective：To examine the benefits, risks associated with tranexamic acid in infants（〈10kg） undergoing low complexity procedures such as the repair of ventricular septal defect（ASD） or atrial septal defect（VSD）. Methods： In a prospective, randomized, blind study, 80 infants, age〈1 year old, with no cyanotic disease such as ASD or VSD undergoing cardiac surgery were investigated. In Group one（n = 40） patients acted as control and received normal saline. In Group two（n = 40） patients received tranexamic acid （30mg·kg^-1 after induction of anesthesia, 30 mg·kg^-1 in the pump prime and 30mg·kg^-1 after weaning from bypass）. Postoperately, total mediastinal chest drainage and transfusion requirements at 24 hours were recorded. Test of coagulation including fibrinogen, fibrin degradation products D-dimer levels and platelet counts before and after operation were perfomed and data were also analyzed and recorded. Results： postoperative blood lose was significantly higher in the control group （Group one）compared with the drug treated group（Group two） （11.9 ± 9.3mL·kg^-1 and 9.0 ± 4.8 mL·kg^-1,P〈0. 05） ,and the patients on treatment have 24% less bleeding in the first 24 hours after surgery. The total transfusion requirements were no less in the treatment group. D-dimer levels were lower in the treatment group, the other coagulation paraments were not found to be significantly different between the two groups. Conclusions： Our results suggested that tranexamie acid totally dose about 90 mg·kg^-1 was effective to inhibit flbrinolysis and reduce postoperative bleeding in the infants undergoing no complexity cardiac surgery with eardiopulmonary bypass. And no adverse effects attributable to the treatment were observed.

关 键 词：氨甲环酸 先天性心脏病 婴幼儿 体外循环 出血量 

分 类 号：R973.1[医药卫生—药品]