氨甲环酸对Stanford A型主动脉夹层术患者的血液保护作用  

Blood-saving effect of tranexamic acid in patients undergoing Stanford type A aortic dissection surgery

作　　者：徐红党[1] 周俊辉[3] 韩宇[2] 刘旭平[3] 王平凡[4] 高传玉[1] 

机构地区：[1]郑州大学人民医院心内科, 450003 [2]河南省胸科医院麻醉科 [3]郑州大学人民医院心外ICU, 450003 [4]河南省胸科医院心外科

出　　处：《中华麻醉学杂志》2015年第8期983-986,共4页Chinese Journal of Anesthesiology

摘　　要：目的 探讨氨甲环酸对Stanford A型主动脉夹层术患者的血液保护作用.方法 急诊行Stanford A型主动脉夹层术患者56例,性别不限,年龄34～58岁,体重62～84 kg,ASA分级Ⅱ或Ⅲ级,左室射血分数＞40％.采用随机数字表法分为对照组（C组,n=26）和氨甲环酸组（TA组,n=30）.TA组于切皮前经30 min静脉输注氨甲环酸负荷剂量10 mg/kg,继以10 mg·kg-1·h-1速率持续静脉输注至术毕;C组给予等容量生理盐水.记录术后24 h总引流量,术后异体红细胞、血浆及血小板使用量和二次开胸止血情况,记录术后机械通气时间、ICU停留时间及术后并发症发生情况.结果 与C组比较,TA组术后24 h总引流量和术后异体红细胞、血浆及血小板用量减少,二次开胸止血率降低,机械通气时间和ICU停留时间缩短,术后急性肺损伤和短暂性神经功能障碍发生率降低（P＜0.05）.结论 氨甲环酸对Stanford A型主动脉夹层术患者具有血液保护作用,可减少术后出血与异体输血.Objective To investigate the blood-saving effect of tranexamic acid in patients undergoing Stanford type A aortic dissection surgery.Methods Fifty-six patients of both sexes with acute Stanford type A aortic dissection, aged 34-58 yr, weighing 62-84 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ , with their left ventricular ejection fraction 〉 40%, undergoing emergency surgery, were randomly divided into 2 groups： control group （group C, n=26） and tranexamic acid group （group TA, n=30）.Tranexamic acid was infused as a bolus of 10 mg/kg over 30 min before skin incision followed by an infusion of 10 mg · kg-1 · h-1 throughout the surgery in group TA.The equal volume of normal saline was given instead in group C.The total volume of drainage at 24 h after operation, the postoperative requirement of allogeneic red blood cells, fresh frozen plasma and platelets, and re-thoracotomy for bleeding were recorded.The postoperative mechanical ventilation time, duration of intensive care unit stay, and complications after operation were also recorded.Results Compared with group C, the total volume of drainage at 24 h after operation, and the requirement of allogeneic red blood cells, fresh frozen plasma and platelets were significantly reduced, the incidence of rethoracotomy for bleeding was decreased, the postoperative mechanical ventilation time, and duration of intensive care unit stay were shortened, and the incidence of postoperative acute lung injury and transient neurological dysfunction were decreased in group TA.Conclusion Tranexamic acid has blood-saving effect and can reduce postoperative bleeding and allogeneic blood transfusion in patients undergoing Stanford type A aortic dissection surgery.

关 键 词：氨甲环酸 动脉瘤 夹层 输血 

分 类 号：R543.1[医药卫生—心血管疾病]