氨甲环酸联合乌司他丁对二尖瓣膜置换术患者血液的保护作用研究  

Protective effect of tranexamic acid combined with ulinastatin on blood in patients undergoing cardiac valve replacement

作　　者：张熠[1] 张文林[1] 母存富 

机构地区：[1]广元市第一人民医院心胸外科,四川广元628017

出　　处：《海南医学院学报》2014年第9期1217-1219,1222,共4页Journal of Hainan Medical University

基　　金：四川省产学研创新联盟合作项目(2011ZO1198)~~

摘　　要：目的：探讨氨甲环酸联合乌司他丁对二尖瓣膜置换术患者血液的保护作用，为更合理地应用氨甲环酸和乌司他丁提供理论依据。方法：选择96例行二尖瓣置换术患者，随机平均分为氨甲环酸联合鸟司他丁组（A组）、氨甲环酸组（B组）、乌司他丁组（C组）、对照组（D组），分别于术前及术后1、4、12h测定4组患者的血小板（PLT）、血红蛋白（Hb）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）及二聚体（D—D）水平，同时记录术后输血量，0-8、9-16、17-24、24h以后4个时间段的引流量。结果：4组患者术后1、4、12h的PLT计数和Hb与术前相比差异均有统计学意义（P〈0．05），而A组、B组、C组术后各时间点PLT计数和Hb与D组相比差异有统计学意义（P〈0．05）；4组患者术后1、4h的PT和APTT水平与术前相比差异有统计学意义（P％0．05），而A组、B组、C组术后各时间点PT和APTT水平与D组相比差异有统计学意义（P〈0．05）；4组患者术后1、4h的FIB和D—D水平与术前相比差异有统计学意义（P〈0．05），D组术后12hFIB和D—D水平与术前相比差异有统计学意义（P％0．05），而A组、B组、C组术后各时间点FIB和D-D水平与D组相比差异有统计学意义（P〈0．05）；4组患者术后0-8、9-16、17-24h引流量、总引流量及输血量差异均有统计学意义（P〈0．05）。结论：氨甲环酸联合乌司他丁对二尖瓣膜置换术患者有血小板保护作用和抗纤溶作用，显著减少术后输血量，值得临床推广。Objective： To investigate the protective effect of tranexamic acid combined with ulinastatin on blood in pa- tients undergoing cardiac valve replacement, and provide a theoretical basis for the reasonable application of tranexamic acid and ulinastatin. Methods： A total of 96 patients undergoing cardiac valve replacement were randomly divided into tranexamic acid combined with ulinastatin group （group A）, tranexamic acid group（group B）, ulinastatin group （group C）, control group （group D）. In the preoperative, postoperative 1 h, 4 h, 12 h, PLT, Hb, PT, APTT, FIB and D-D levels were measured in four groups, and the postoperative blood transfusion volume and the drainage volume 0-8 h, 9-16 h, 17-24 h, 24 h after the four time periods were recorded. Results： After 1 h, 4 h, 12 h, there were significant changes in PLT count and Hb after surgery in the four groups （P%0.05）, while PLT count and Hb in group A, group B, group C at each time point after operation were significantly different from that of the group D （P%0.05）. After postoperative 1 h, 4 h, there were significant changes in PT and APTT levels of the four groups after operation （P〈0.05）, while those in group A, group B, group C at each time point after operation were significantly different from those of group D （P（0.05）. After 1 h, 4 h, there were significant chan- ges in FIB and D-D levels of four groups after operation （P〈0.05）, FIB and D-D levels of group D before and 12 h after treat- ment were significantly different （P〈0.05）, while FIB and D-D levels in group A, group B, group C at each time point after operation were significant different from group D （P〈0.05）. There were significant difference in drainage, drainage and blood transfusion volume after postoperative 0-8 h, 9-16 h, 17-24 h of four groups （P〈0.05）. Conclusion.. Tranexamic acid com- bined with ulinastatin has the protective effect on anti platelet and fibrinolysis in patients with cardiac valve replacement. It can significan

关 键 词：二尖瓣膜置换术 氨甲环酸 乌司他丁 血液保护 

分 类 号：R542.51[医药卫生—心血管疾病]