不同剂量氨甲环酸减少心脏手术体外循环后出血和输血的有效性和安全性比较  

Blood-saving Effect and Safety of Tranexamic Acid in Patients Receiving Cardiac Surgery with Cardiopulmonary Bypass

作　　者：周勇 胡文军[2] 郭镜飞 吕焕然 袁素[1] 王古岩[1] 石佳[1] 李立环[1] ZHOU Yong;HU Wen-jun;GUO Jing-fei;LV Huan-ran;YUAN Su;WANG Gu-van;SHI Ji;LI Li-huan(Fuwai Hospital, Chinese Academy of Medical Sciences Beijing 100037, China;Department of Anesthesiology, No. 305 Hospital of PLA, Beijing 100017, China.)

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外医院麻醉中心,北京市100037 [2]中国人民解放军第三0五医院麻醉科,北京市100017

出　　处：《中国分子心脏病学杂志》2018年第2期2419-2422,共4页Molecular Cardiology of China

摘　　要：目的评估三种不同剂量氨甲环酸减少体外循环冠脉旁路移植术和瓣膜置换术出血和输血的有效性和安全性。方法入选择期体外循环冠脉旁路移植术或瓣膜置换术患者共150例,随机分为低剂量组、中剂量组和高剂量组,每组各50例。氨甲环酸采用负荷量加维持量的给药方式,负荷量在低、中、高三个剂量组中分别为10 mg/kg、20 mg/kg和30 mg/kg,维持量分别为10 mg.kg-1.min-1、15mg.kg-1.min-1、20 mg.kg-1.min-1。记录术后引流量、异体血输注量和输注率、术后并发症发生率以及死亡率。结果三组患者术后引流量在0~8h、9~16h、17~24h、25~48h、48h后至拔除引流管五个时间段以及总引流量的差异均具有统计学意义,与低剂量和中剂量相比,高剂量能够进一步减少术后引流量。三个剂量组的异体血输注量和输注率差异没有统计学意义。三个剂量组的术后并发症和死亡率差异没有统计学意义。结论高剂量氨甲环酸可减少体外循环冠脉旁路移植术和瓣膜置换术术后出血量,但并不减少异体血输注量和输注率。不同剂量氨甲环酸对术后并发症和死亡率没有显著影响。Objective To compare the blood-saving effect and safety of different doses of tranexamic acid in cardiac surgery. Methods One hundred and fifty coronary artery bypass graft or cardiac valvular surgery patients were randomly divided into 3 groups according to the dose of tranexamic acid： low dose group（n =50）, the loading dose was 10 mg/kg and followed by maintance dose of 10 mg.kg-1.min-1; moderate dose group（n =50）, the loading dose was 20 mg/kg and maintenance dose was 15 mg.kg-1.min-1; high dose group（n =50）, the loading dose was 30 mg/kg and maintenance dose was 20 mg.kg-1.min-1. The volume of chest tube drainage was recorded at 8 h, 16 h,24 h and 48 h after operation. The total volume of chest drainage was calculated when the drainage tubes were removed. The transfusion of allogenic red blood cells（R BC）, platelet（Plt） and f resh f rozen plasma（FFP） were also recorded. Postoperative complications and mor tality were collected. Results There were signif icant differences in the volume of chest tube drainage at 0 to 8 h, 17 to 24 h, 25 to 48 h, 48 h after operation and the total drainage volume after operation（P〈 0.05）. High dose group had less postoperative blood loss. However, there were no sig nif icant differences in the requirements for t ransf usion of allogenic R BC, Plt and FFP（P〉 0.05）. No fatalities occur red during the hospital stay in any of the 3 groups. There were no significant differences in postoperative complications in the three groups. Conclusions High dose of tranexamic acid may decrease the blood loss after cardiac valvular or coronary artery bypass graft surgery with cardiopulmonary bypass but have no significant effects on postoperative complications or mortality.

关 键 词：氨甲环酸 体外循环 术后出血 异体血输注 

分 类 号：R654.2[医药卫生—外科学]