氨甲环酸减少体外循环心脏瓣膜置换术后出血的最佳使用时间  

The optimal application time of tranexamic acid in the cardiac valve replacement with cardiopulmonary bypass to reduce postoperative bleeding

作　　者：张颖[1] 宋建萍[1] 陈振强[1] 张辉[1] 赵扬[1] 叶生爱[1] 程亮[1] 

机构地区：[1]江苏省中医院心胸外科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2010年第10期1448-1451,1474,共5页Journal of Nanjing Medical University(Natural Sciences)

摘　　要：目的:观察体外循环心脏瓣膜手术中氨甲环酸的不同给药时间和术后早期出血、抗纤溶效果和血小板保护之间的关系。方法:45例心脏瓣膜病患者随机分为3组:TA-1组:体外循环中使用氨甲环酸1.0g,其中0.5g于体外循环开始后15min快速滴入,另外0.5g缓慢滴入维持至体外循环结束;TA-2组:体外循环结束使用鱼精蛋白中和肝素后使用氨甲环酸1.0g静滴。对照组:体外循环中及结束后均不使用氨甲环酸。观察3组患者术后6、24h的出血量、24h红悬、血浆输入量,术后6hD-二聚体及血小板计数。结果:TA-1组、TA-2组术后6、24h出血量及红悬、血浆输入量较对照组均显著减少。TA-1组同TA-2组相比,术后6、24h的出血量显著减少,而24h血制品输入量较B组有减少趋势。3组间术后6h的D-二聚体水平比较TA-1组<TA-2组<对照组,即TA-1组显著低于TA-2组和对照组,而TA-2组显著低于对照组。术后6h血小板计数比较显示TA-1组明显高于TA-2、对照组,而后两组之间无显著性差异。结论:体外循环心脏瓣膜置换术中使用氨甲环酸较空白对照组可有效减少术后早期出血和血制品输入,体外循环中氨甲环酸持续静滴的止血、抗纤溶、血小板保护的效果要优于体外循环结束后单剂量给药的效果。Objective：Evaluate the effect of tranexamic acid with different application time on postoperative bleeding,fibrinolytic activity and platelet function in cardiac valve replacement with cardiopulmonary bypass.Methods：Forty-five patients with heart valve disease were randomly divided into three groups.Group TA-1 received 0.5 g tranexamic acid within 15 min at the beginning of cardiopulmonary bypass,followed by continuous infusion of another 0.5 g during cardiopulmonary bypass.Group TA-2 received 1.0 g tranexamic acid after the bypass.Group control received nothing during and after bypass.Cumulative blood loss at 6 h and 24 h,blood transfusion at 24 h,D-dimer level and platelet count at 6 h after surgery were recorded.Results：Postoperative blood loss and transfusion were significantly reduced in group TA-1 and TA-2 when compared with the control group.Group TA-1 has less blood loss at 6 h and 24 h than group TA-2.The blood transfusion was also less in group TA-1 than TA-2,however the difference was not significant.There was a significant increase in plasma D-dimer level at 6 h after surgery.Among the three groups,group TA-1 has the lowest D-dimer level,which is lower in group TA-2 than in the control group.Platelet count at 6 h after surgery was similarly reduced in the TA-2 group and control group,which was significantly less than that of TA-1 group.Conclusion：Tranexamic acid effectively reduces postoperative bleeding and blood transfusion in patients undergoing cardiac valve replacement with cardiopulmonary bypass compared to the control.Continuous application of tranexamic acid during the cardiopulmonary bypass has a better effect than a single dose after bypass on postoperative bleeding,blood transfusion,anti-fibrinolysis and platelet protection.

关 键 词：氨甲环酸 体外循环 心脏瓣膜置换术 

分 类 号：R654.1[医药卫生—外科学]