体外循环冠状动脉旁路移植术中抗纤溶治疗的有效性和安全性  

Effectiveness and safety of anti-fibrinolytic therapy in on-pump CABG

作　　者：王瑾[1] 张昱[2] 肖文静[2] 金蕾 张玉林[2] 石佳[2] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院麻醉科,100730 [2]中国医学科学院,北京协和医学院,国家心血管病中心,心血管疾病国家重点实验室,阜外医院麻醉中心

出　　处：《中华医学杂志》2017年第40期3147-3151,共5页National Medical Journal of China

摘　　要：目的评估体外循环冠状动脉旁路移植术中应用氨甲环酸抗纤溶治疗的有效性和安全性。方法本研究为前瞻性随机、双盲、对照临床试验。2014年10月至2017年2月于阜外医院纳入211例择期行体外循环冠状动脉旁路移植术的患者，通过计算机生成随机数序列，随机分为试验组（105例）和对照组（106例），麻醉诱导后试验组予以氨甲环酸负荷量10 mg/kg静脉输注，继以维持量10 mg·kg^－1·h^－1持续泵注至术毕，对照组予以等量生理盐水输注。记录术后失血和异体血制品输注情况、并发症和不良事件发生率、死亡发生率。结果试验组和对照组患者基线人口统计学资料、既往史、心血管病高危因素和术前用药差异均无统计学意义（均P〉0.05）。试验组和对照组术后失血量分别为860（670, 1 190）ml和985（783, 1 365）ml，红细胞输注量为2（0，8）U和6（2，10）U，血浆输注率为53.33%和70.75%，血浆输注量为1（0, 3）U和2（0, 3）U，两组比较差异均有统计学意义（均P〈0.05）。两组患者术后并发症及不良事件发生率、死亡发生率差异均无统计学意义（均P〉0.05）。结论氨甲环酸可产生有效的抗纤溶作用，减少体外循环冠状动脉旁路移植术后出血和异体血制品输注，且未观察到严重不良反应。ObjectiveTo evaluate the effectiveness and safety of anti-fibrinolytic therapy in on-pump coronary artery bypass grafting （CABG）. MethodsTwo hundred and eleven patients receiving on-pump CABG in Fuwai Hospital were recruited and randomized into treatment group （group T） and control group （group C） between October 2014 and February 2017. Tranexamic acid was given with a 10 mg/kg loading dose and 10 mg·kg^-1·h^-1 infusion dose to group T and equal volume of saline was given to group C throughout the surgery. Postoperative drainage, allogeneic transfusion, complications, adverse events and mortality were recorded.ResultsPatients of group T had less postoperative drainage [860 （670, 1 190）ml vs 985 （783, 1 365）ml], decreased red blood cell [2 （0, 8）U vs 6 （2, 10）U] and fresh frozen plasma [1 （0, 3） U vs 2 （0, 3）U] transfusion volume, lower fresh frozen plasma transfusion rate （53.33% vs 70.75%） than patients of group C （all P〈0.05）. No statistically significant differences existed in the rate of postoperative complications, adverse events and death between the two groups （all P〉0.05）.ConclusionTranexamic acid has definite anti-fibrinolytic effect, which can significantly reduce postoperative bleeding and allogeneic transfusion while no severe side effects were observed.

关 键 词：冠状动脉分流术 氨甲环酸 体外循环 抗纤溶作用 

分 类 号：R614[医药卫生—麻醉学]