中性粒细胞弹性蛋白酶在体外循环心脏手术围术期抗纤溶治疗中的变化  

Effect of Antifibrinolytic Therapy on Plasma Neutrophil Elastase in Patients Receiving Cardiac Surgery with Cardiopulmonary Bypasss

作　　者：吕红[1] 张昱[1] 袁素[1] 陈芳[1] 石晟[1] 杨丽静[1] 康文英 石佳[1] LV Hong;ZHANG Yu;YUAN Su;CHEN Fang;SHI Sheng;YANG Li-jing;KANG Wen-ying;SHI Jia(Department of Anesthesiology,Fuwai Hospital Chinese Academy of Medical Sciences,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心血管病疾病国家重点实验室阜外医院麻醉中心

出　　处：《中国分子心脏病学杂志》2019年第2期2830-2834,共5页Molecular Cardiology of China

摘　　要：目的评估中性粒细胞弹性蛋白酶(NE)在体外循环心脏手术围术期应用氨甲环酸抗纤溶治疗中的变化,同时观察氨甲环酸对围术期出血和输血的影响与NE水平变化的相关性。方法本研究为前瞻性、随机对照、双盲临床试验。入选101例择期行体外循环心脏手术的患者,随机分为对照组(n=50例)和试验组(n=51例)。试验组麻醉诱导后20min给予氨甲环酸负荷剂量10mg/kg,随后给予维持量10mg/(kg·h)直至手术结束,对照组给予等量生理盐水输注。试验组和对照组各顺序取20例受试者,在手术开始前、手术结束即刻、术后6h和术后24h四个时间点分别取静脉血3ml,ELISA法测定NE。记录术后出血量、输血量、实验室检查、并发症和不良事件发生率等。结果试验组和对照组患者一般资料和围术期临床数据间差异无统计学意义(P>0.05)。试验组和对照组血浆NE手术后6h分别为(130.65±107.69)ng/ml和215.71±78.16ng/ml,手术后24h分别为(381.79±173.36)ng/ml和(608.67±229.72)ng/ml,差异具有统计学意义(P<0.01)。试验组和对照组的术后总引流量分别为(737.22±270.57)ml和(1167.64±480.64)ml,差异具有统计学意义(P<0.01)。试验组的异体血制品输注量明显低于对照组,红细胞输注量分别为(2.15±1.92)11和(4.98±4.32)U,血浆分别为401.57±398.52ml和664.4±563.02ml,差异具有统计学意义(P<0.05)。两组患者术后并发症和不良事件发生率等差异无统计学意义。结论体外循环心脏手术中NE水平在手术后6h和24h显著升高,氨甲环酸可以显著降低NE的升高,且可以显著减少围手术期出血量和异体血制品输注量。Objective To evaluate the changes of tranexamic acid on neutrophil elastase in patients receiving cardiac surgery with cardiopulmonary bypass and observe the correlation in postoperative bleeding and allogeneic blood transfusion according to the change of neutrophil elastase at the same time. Methods One hundred and one patients receiving cardiac surgery with cardiopulmonary bypass were recruited and randomized into treatment group and control group. Tranexamic acid was given with a 10 mg/kg loading dose and 10 mg/(kg·h)infusion dose to treatment group and equal volume of saline was given to control group throughout the surgery. Twenty patients were selected in each group and measured and recorded the indexes of neutrophil elastase at four defferent timing. Postoperative drainage, allogeneic transfusion,laboratory examination related, complications and adverse events were recorded. Results The indexes of neutrophil elastase in treatment group and control group was(130.65±107.69)ng/ml and(215.71±78.16)ng/ml respectively at 6 hours after the operation and was(381.79±173.36)ng/ml and(608.67±229.72)ng/ml respectively at 24 hours after the operation with a p value 0.01. Postoperative drainage in treatment group and control group was(737.22±270.57)ml and(1167.64±480.64)ml respectively with a p value 0.01. Red blood cell transfusion volume was(2.15±1.92)U and(4.98±4.32)U in the treatment group and the control group respectively, fresh frozen plasma transfusion volume was(401.57±398.52)ml and(664.4±563.02)ml in the treatment group and the control group respectively with statistical significance(P0.05). No statistically significant differences existed in the rate of postoperative complications and adverse events between the two groups. Conclusion The indexes of neutrophil elastase in patients receiving cardiac surgery with cardiopulmonary bypass has significant increase at 6 and 24 hours after the operation. Tranexamic acid can significantly decrease the increase of neutrophil elastase and reduce postoperative

关 键 词：体外循环 心脏手术 氨甲环酸 中性粒细胞弹性蛋白酶 抗纤溶作用 

分 类 号：R654.2[医药卫生—外科学]