氨甲环酸对法洛四联症矫治术患儿围手术期血液保护作用及远期预后的影响  

Effects of tranexamic acid on the blood conservation and the long-term prognosis in pediatric patients undergoing repair for tetralogy of fallot

作　　者：张昱[1] 王嵘[1] 王宇红[1] 王海凌 田鹏声[1] 贾爰[1] 龚俊松[1] 晏馥霞[1] Zhang Yu;Wang Rong;Wang Yuhong;Wang Hailing;Tian Pengsheng;Jia Yuan;Gong Junsong;Yan Fuxia(Department of Anesthesiology,Fu Wai Hospital,National Centerfor 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

出　　处：《中华医学杂志》2019年第45期3564-3567,共4页National Medical Journal of China

基　　金：中央高校基本科研业务费专项基金(3332018064)。

摘　　要：目的评价氨甲环酸(TXA)对接受法洛四联症(TOF)矫治术患儿围术期的血液保护作用及对近、远期不良事件发生率和病死率的影响.方法回顾性队列研究.连续选取本院2009年1月—2010年12月首次接受TOF矫治术的386例患儿,根据术中是否应用TXA被分为TXA组(n=225)和对照组(n=161),年龄31 d-8岁,美国麻醉医师协会分级为Ⅱ或Ⅲ级;麻醉医师在术后第8年对患儿家属进行电话随访.记录并统计分析患儿主要的围术期出血和输血情况,以及术后近、远期不良事件的发生率和病死率.结果TXA组术后12 h出血量为(7.8±0.3)ml/kg,术后总出血量为(14.0±0.6)ml/kg,少于对照组的(8.8±0.3)ml/kg和(17.0±0.7)ml/kg,差异均有统计学意义(t=2.412、3.141,均P<0.05).两组患者间红细胞、血浆和血小板输注量及输注率的差异均无统计学意义(均P>0.05).两组患者间二次开胸止血率、术后长时间机械通气发生率、ICU停留时间、术后住院时间以及癫痫、卒中、肾功能衰竭、下肢深静脉血栓、肺动脉血栓发生率和病死率的差异均无统计学意义(均P>0.05).结论TXA可有效降低接受TOF矫治术患儿的术后出血,对术后异体血制品的输注没有影响,对术后近、远期不良事件的发生率和病死率亦无影响.Objective To evaluate the perioperative tranexamic acid(TXA)on blood conservation in pediatric patients undergoing complete repair for tetralogy of fallot(TOF)and its impact on short-term or long-term adverse event and mortality.Methods The study was a retrospective cohort study.From January 2009 to December 2010,386 consecutive patients aged from 31 days to 8 years old,ASA physical statusⅡorⅢ,receiving primary complete repair for TOF in Fuwai Hospital were enrolled in the study.They were divided into two groups:the control group(n=161)and the TXA group(n=225),according to whether TXA was used during the operation.Patients and their families were followed up by telephone in the 8th-year after surgery.The amount of perioperative blood loss,allogeneic transfusion,short-term or long-term adverse event and mortality were recorded and analyzed.Results The patients in the TXA group were associated with significant decreased 12 h and total postoperative blood loss compared with the control group[(7.8±0.3)ml/kg vs(8.8±0.3)ml/kg,t=2.412,P<0.05;and(14.0±0.6)ml/kg vs(17.0±0.7)ml/kg,t=3.141,P<0.05].There were no significant differences in both the volume and incidence of red blood cell,plasma,and platelet transfusion,postoperatively(P>0.05).There were no significant differences in the incidence of reoperation for bleeding and prolonged mechanical ventilation,ICU stay,postoperative hospital length of stay,the short-term and long-term incidence of seizure,stroke,renal failure,deep venous thrombosis,pulmonary embolism and death between the two groups(P>0.05).Conclusion TXA can decrease postoperative blood loss,but has little impact on the allogeneic blood transfusion,as well as the short-term or long-term adverse event and mortality in pediatric patients undergoing complete repair for TOF.

关 键 词：氨甲环酸 法洛四联症 手术中并发症 输血 预后 

分 类 号：R47[医药卫生—护理学]