氨甲环酸对室间隔缺损患儿围术期的血液保护作用的影响  

The blood protective effects of tranexamic acid in ventricular septal defect children undergoing cardiac surgery

作　　者：张昱[1] 然鋆[2] 石佳[1] 崔勇丽[3] 刘晋萍[3] 晏馥霞[1] Zhang Yu;Ran Jun;Shi Jia;Cui Yongli;Liu Jinping;Yan Fuxia(Department of Anesthesiology,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院麻醉中心,北京100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院成人外科中心,北京100037 [3]中国医学科学院北京协和医学院国家心血管病中心阜外医院体外循环中心,北京100037

出　　处：《中国体外循环杂志》2018年第3期146-149,共4页Chinese Journal of Extracorporeal Circulation

基　　金：首都临床特色应用研究(Z131107002213172)

摘　　要：目的评价氨甲环酸(TXA)对室间隔缺损(VSD)患儿围术期的血液保护作用及对住院费用和死亡率的影响。方法本研究为回顾性病例对照研究。选取本院于2013年7月至2015年6月接受VSD修补术的单纯VSD患儿1 236名。根据术中是否应用TXA被分为两组:对照组(n=648)和TXA组(n=588),年龄2个月~12岁,ASA分级Ⅱ~Ⅲ级。记录并统计分析患儿主要的围术期出血和输血以及住院费用和死亡率。结果一般线性回归显示两组患者间术中出血量的差异无统计学意义(P>0.05)。与对照组比较,TXA组术后出血量显著减少且有统计学意义(MD:13.52 ml,P<0.001);TXA组的红细胞输注量显著降低且有统计学意义(MD:0.20 U,P<0.001);TXA组的血浆输注量显著降低且有统计学意义(MD:10.21 ml,P<0.001)。多元logistic回归显示TXA显著降低患者的红细胞输注率(OR:0.666,P<0.001)和血浆输注率(OR:0.668,P=0.001),术中应用TXA为保护因素。两组患者间术后机械通气时间、ICU停留时间、术后住院时间、住院总花费、出血而二次开胸的发生率和死亡率差异无统计学意义(P>0.05)。结论 TXA可降低VSD患儿围术期的出血和输血的风险,对住院费用和住院死亡率没有影响。Objective To evaluate the effects of tranexamic acid（ TXA） on blood protection,in-hospital cost and mortality in pediatric patients undergoing ventricular septal defect（ VSD） repair surgery. Methods The study was an observational case-control trial. During July 2013 to June 2015,1236 consecutive patients aged from 2 months to 12 years received VSD repair surgery in Fuwai hospital were enrolled in the study. They were divided into two groups： control group（ n = 648） and TXA group（ n = 588）. The pediatric patients’ incidences of major perioperative blood loss,any allogeneic transfusion,in-hospital cost and mortality were recorded and analyzed. Results General linear regression analysis revealed that there was no significant difference in the intraoperative blood loss between the two groups（ P 〉0.05）. Compared with control group,patients in TXA group were associated with significant decreased postoperative blood loss（ MD： 13.52 ml,P 〈0.001）. Compared with control group,TXA significantly reduced the amount of allogeneic red blood cell transfusion（ MD： 0.20 U,P 〈0.001） and plasma transfusion（ MD： 10.21 ml,P 〈0.001）. Multivariate logistic regression analysis revealed that TXA was a protective factor associated with the exposure of allogeneic red blood cell transfusion（ OR： 0.666,P 〈0.001） and plasma transfusion（ OR： 0.668,P = 0.001）. There was no significant difference in postoperative ICU stay,mechanical ventilation time,postoperative hospital length of stay,reoperation for bleeding,mortality and in-hospital cost between the two groups（ P 〉0.05）. Conclusion TXA significantly decreased postoperative blood loss and allogeneic transfusion in VSD patients undergoing cardiac surgery. Moreover,TXA did not affect in-hospital cost and mortality in pediatric patients undergoing VSD repair surgery.

关 键 词：氨甲环酸 体外循环 室间隔缺损 

分 类 号：R726.5[医药卫生—儿科]