氨甲环酸不同给药方式对浅低温体外循环手术患者血液保护作用的临床研究  

Clinical trial on the protective effect of tranexamic acid on blood by different administrations in patients undergoing mild hypothermic cardiopulmonary bypass

作　　者：熊达 刘志良[3] 李洪荣 任文俊[2] 代国林 XIONG Da;LIU Zhi-liang;LI Hong-rong;REN Wen-jun;DAI Guo-lin(Graduated School,Jinzhou Medical University,Jinzhou 121001,Liaoning Province,China;Department of Cardiovascular Surgery,The First People＇s Hospital of Yunnan,Kunming 650032,China;Department of Cardiovascular Surgery,The First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121001,Uaoning Province,China)

机构地区：[1]锦州医科大学研究生学院,辽宁锦州121001 [2]云南省第一人民医院心脏大血管外科,昆明650032 [3]锦州医科大学附属第一医院心胸外科,辽宁锦州121001

出　　处：《中国临床药理学杂志》2018年第15期1831-1834,共4页The Chinese Journal of Clinical Pharmacology

摘　　要：目的研究体外循环(CPB)心脏手术中氨甲环酸经不同方式给药,其血液保护作用的不同。方法将于我院择期进行浅低温体外循环心脏手术患者90例随机分为A,B,C组,每组30例,各组均给予氨甲环酸30 mg·kg^(-1)。A组在体外循环预充液中加入氨甲环酸,B组在切皮前由中心静脉注射氨甲环酸,C组在切皮前由中心静脉持续泵入氨甲环酸3 h。检测记录患者术前(T_0)、手术结束时(T_1)、术后6(T_2)、术后12(T_3)、术后24(T_4)、术后48 h(T_5)各时间点血小板(PLT)、血红蛋白(HGB)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)、纤维蛋白原(FIB)、D-二聚体(D-dimer);记录术后6,12,24,48 h的心包纵隔引流液总量。统计患者术后主要并发症的发生率,并定期随访患者至术后90 d,记录各种原因造成的死亡病例。结果手术结束时,C组较A组和B组PLT、HGB、FIB下降更多,差异有统计学意义(P<0.05),术后12 h,A,B,C组术后引流量分别为(391.00±242.87),(395.50±241.85),(585.50±241.86)m L,C组较A、B组引流量更多,差异有统计学意义(P<0.05),而A与B组间差异无统计学意义(P>0.05)。各组间术后90 d内手术并发症发生率及死亡率差异无统计学意义(P>0.05)。结论同等剂量氨甲环酸用中心静脉注射和CPB预充两种给药方式血液保护作用均优于持续中心静脉泵入,中心静脉注射氨甲环酸和CPB预充氨甲环酸的血液保护作用差异无统计学意义。Objective To study the differences in blood protection effect of tranexamic acid in cardiopulmonary bypass（ CPB） heart surgery.Methods Ninety patients undergoing elective hypothermic cardiopulmonary bypass in our hospital were randomly divided into group A,B and C,with 30 cases in each group. Each group received 30 mg · kg^（-1） tranexamic acid. In group A,tranexamic acid was added to the extracorporeal circulation priming solution. In group B,tranexamic acid was injected from the central vein before skin incision. In group C,tranexamic acid was continuously pumped from the central vein for 3 h before skin incision. The platelet（ PLT）,hemoglobin（ HGB）,activated partial thromboplastin time（ APTT）,international normalized ratio（ INR）,fibrinogen（ FIB）,D-dimer at preoperative（ T_0）,end of surgery（ T_1）,postoperative 6（ T_2）,12（ T_3）,24（ T_4）,and 48 h（ T_5） were observed. The total volume of pericardial septum drainage fluid wasrecorded at 6,12,24,48 h postoperative. The incidence of major postoperative complications was counted,and the patients were followed up regularly for 90 d after surgery. Deaths due to various causes were recorded. Results The PLT,HGB and FIB in group C decreased more than those in group A and group B at the end of surgery,the difference was statistically significant（ P 0. 05）. At 12 h after operation,the postoperative drainage in group A,B and C were（ 391. 00 ± 242. 87）,（ 395. 50 ± 241. 85）,（ 585. 50 ± 241. 86） m L,the group C had more blood loss within 12 h than other two groups. The difference was statistically significant（ P 0. 05）,but there was no significant difference between the group A and group B（ P 0. 05）. There was no significant difference in the incidence of surgical complications and mortality within 90 d after surgery（ P 0. 05）. Conclusion At the same dose of methicocyclic acid,the blood protective effects of methicocyclic acid administrated by central vein injection and CPB precharge were superio

关 键 词：氨甲环酸 体外循环 凝血功能障碍 出血量 

分 类 号：R97[医药卫生—药品]