氨甲环酸在体外循环冠状动脉旁路移植术中的血液保护作用及术后5年随访  

The Effect of Blood Conservation of Tranexamic Acid in Patients Undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass and 5-year Follow-up

作　　者：吕焕然 周勇 宋翔 张昱[1] 肖文静 王越夫[1] 薛庆华[1] 王古岩[1] 石佳[1] 

机构地区：[1]北京协和医学院中国医学科学院阜外医院麻醉中心,北京市100037

出　　处：《中国分子心脏病学杂志》2017年第5期2232-2235,共4页Molecular Cardiology of China

摘　　要：目的研究氨甲环酸在体外循环冠状动脉旁路移植术中的血液保护作用的有效性及安全性,并进行术后5年随访。方法本研究为前瞻性、随机、双盲、对照的临床研究,选取体外循环冠状动脉旁路移植术患者共200例,并将其随机分为2组:氨甲环酸组(T组,n=100)和空白对照组(C组,n=100)。在麻醉诱导后20分钟内给予T组患者静脉输注氨甲环酸负荷剂量10mg/kg,再以10mg/kg·h静脉维持至术毕,C组则给予等容量生理盐水作为对照。统计患者术后引流量、异体血输注量和输注率、术后相关并发症等情况,并随访至术后5年。结果 T组的术后住院时间、术后引流量、以及异体红细胞和血浆的使用率和用量均显著小于C组(P<0.05)。两组间在术后院内并发症并无显著统计学差异(P>0.05)。两组患者术后5年内重要并发症和死亡率无统计学差异(P>0.05)。结论氨甲环酸可显著减少体外循环冠状动脉旁路移植术的围术期出血量、异体血输注量和输注率,术后5年内不增加相关并发症发生率和死亡率。Objective To investigate the effectiveness and safety of blood conservation of tranexamic acid（TXA） in patients undergoing with coronary artery bypass grafting（CABG） with cardiopulmonary bypass（CPB） and to follow up for five years.Methods We presented a design of single center,randomized,double-blind,placebo-controlled trial,in which 200 patients underwent CABG with CPB were involved.These patients were randomized into two groups,TXA exposed group（group T,n=100） and placebo-control group（group C,n=100）.The patients of group T received a loading dose（10 mg/kg） of TXA within 20 minutes,and the maintenance dose was 10 mg/kg·h.While the patients of group C received the same volume of normal saline.The total volume of drainage postoperative,the consumption of allogenetic blood,the mortality and morbidity of related complications were recorded.We followed up all the patients for five years.Results Compared with group C,the length of hospital stay,the total volume of drainage postoperative and the consumption of allogenetic red blood cells and fresh frozen plasma were significantly decreased（P〈0.05）.There was no significant difference in morbidity of complications during the 5-year follow-up（P〈0.05）.Conclusion TXA could reduce the blood loss postoperative and the consumption of blood product,while it won＇t increase the mortality and complication morbidity within 5 years postoperative.

关 键 词：氨甲环酸 冠状动脉旁路移植术 体外循环 出血 异体输血 

分 类 号：R654.2[医药卫生—外科学]