氨甲环酸在高龄非体外循环冠状动脉旁路移植术中应用的随机对照试验  

Application of tranexamic acid in elderly patients during off-pump coronary artery bypass grafting: A randomized controlled trial

作　　者：戚晓通[1] 刘锦源[1] 魏磊[1] 王晓伟[1] 

机构地区：[1]南京医科大学第一附属医院胸心外科,南京210029

出　　处：《中国胸心血管外科临床杂志》2017年第8期602-606,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的研究抗纤溶药物氨甲环酸在70岁以上高龄患者非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)中的有效性和安全性。方法选择2014年6月至2016年8月南京医科大学第一附属医院胸心外科择期行OPCABG的340例患者纳入该研究,所有患者年龄均>70岁,其中男282例、女58例。根据电脑随机数字法,患者被随机分为氨甲环酸组(30 mg/kg,麻醉诱导后,给药时间>30 min;n=170)和安慰剂组(同等量的生理盐水;n=170)。主要研究终点为患者术后6 h和24 h引流量;次要研究终点为各种血制品输注量,各种血栓事件发生率,机械通气时间,住重症监护病房(ICU)时间和总住院时间。结果与安慰剂组相比较,氨甲环酸组术后6 h[(275.6±105.1)ml vs.(459.6±110.2)ml,P<0.001]和24 h引流量明显减少[(685.3±202.5)ml vs.(915.9±223.6)ml,P<0.001],术后红细胞输注量[(0.80±0.66)U vs.(1.60±1.30)U,P<0.001]和新鲜冰冻血浆输注量[(166±25)ml vs.(257±30)ml,P<0.001]明显减少,各种血栓事件发生率、机械通气时间、住ICU时间和总住院时间差异无统计学意义。结论在70岁以上高龄患者OPCABG中,氨甲环酸可明显减少术后6 h和24 h引流量和输血量,而且并不增加血栓事件的发生率。Objective To investigate the efficacy and safety of tranexamic acid in patients with the age〉70 years during off-pump coronary artery bypass grafting （OPCABG）. Methods From June 2014 to August 2016, 340 patients undergoing elective OPCABG were included in this study. All the patients were more than 70 years old, among whom 282 were males and 58 were females. According to the random number generation method, the patients were randomly assigned to receive either tranexamic acid （30 mg/kg, infusion time was longer than 30 min after anesthesia induction; n=170） or a placebo （infusion equivalent volume of saline solution; n=170）. The primary end point was chest tube drainage 6 h and 24 h postoperatively. The secondary end points were blood transfusion volumes, incidence of various thrombotic events, duration of mechanical ventilation, length of ICU and hospital stay. Results Compared with patients in the placebo group, the patients receiving tranexamic acid had a significant reduction in chest tube drainage at postoperative 6 h （275.6±105.1 ml vs. 459.6±110.2 ml, P〈0.001） and 24 h （685.3±202.5 ml vs. 915.9±223.6 ml, P〈0.001）. There was also a significant reduction in allogeneic red blood cell transfusion （0.80±0.66 U vs. 1.60±1.30 U, P〈0.001） and fresh frozen plasma transfusion （166±25 ml vs. 257±30 ml, P〈0.001）. There were no significant differences in incidence of various thrombotic events, duration of mechanical ventilation, length of ICU and hospital stay between the two groups. Conclusion Tranexamic acid can significantly reduce blood loss and transfusion in elderly patients 6 h and 24 h after OPCABG and the incidence of thrombotic events will not increase.

关 键 词：氨甲环酸 高龄 非体外循环 冠状动脉旁路移植术 

分 类 号：R654.2[医药卫生—外科学]