体外循环心脏手术中抗纤溶治疗对血栓弹力图结果的影响  

Effect of antifibrinolytic therapy on thromboelastography parameters in patients undergoing cardiac surgery with cardiopulmonary bypass

作　　者：吕红[1] 孟颖[2] 袁素[1] 张磊[1] 刘岳 陈芳[1] 李立环[1] 石佳[1] Lv Hong;Meng Ying;Yuan Su;Zhang Lei;Liu Yue;Chen Fang;Li Lihuan;Shi Jia(Department of Anesthesiology,Fuwai Hospital,National Center of Cardiovascular Diseases,Chinese Academy of Medical Science 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心血管病疾病国家重点实验室阜外医院麻醉中心,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心血管病疾病国家重点实验室阜外医院成人外科中心,北京100037

出　　处：《中国体外循环杂志》2020年第5期274-278,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的评估体外循环心脏手术中抗纤溶治疗对血栓弹力图(TEG)结果的影响,同时观察TEG检测结果中K值、MA值和R值的变化与术后出血和输血情况的相关性。方法本研究是一项前瞻性、随机对照、双盲试验。入选择期行体外循环心脏手术患者共40例,随机分为试验组(n=20)和对照组(n=20)。麻醉诱导后输注负荷剂量氨甲环酸20 mg/kg,持续20 min,随后以15 mg/(kg·h)速度持续输注至手术结束。对照组输注等量0.9%NaCl。于手术开始前(T1)、手术结束即刻(T2)、手术后6 h(T3)和手术后24 h(T4)四个时间点进行TEG检测,并记录TEG检测结果中K值、MA值和R值、出血量、异体血制品输注和相关实验室检查情况,并发症、不良事件和死亡率等。结果受试者术前一般资料和围术期数据,两组间差异无统计学意义。试验组和对照组K值、MA值在T2、T3和T4差异均有显著统计学意义(P<0.01);R值在T3(P<0.05)和T4(P<0.01)均有明显差异。试验组术后总引流量、红细胞和血浆输注量均明显低于对照组(P<0.05)。两组受试者围术期并发症和不良事件的发生率等,差异无统计学意义。结论体外循环心脏手术中TEG检测结果显示应用氨甲环酸抗纤溶治疗可明显降低K值和R值的升高,减弱MA值的降低,且出现与TEG检测结果相一致的围术期出血量和输血量显著降低。本研究未观察到与氨甲环酸抗纤溶治疗相关的不良反应。Objective To assess the effect of antifibrinolytic therapy on thromboelastography(TEG)parameters in patients un⁃dergoing cardiac surgery with cardiopulmonary bypass(CPB)and observe the correlation of the changing of k-Time,MA and r-Time in TEG with postoperative bleeding and allogeneic blood transfusion.Methods A prospective,randomized controlled,double-blind study was conducted in 40 patients underwent selective cardiac surgery with CPB were randomly divided into treatment group and con⁃trol group.Treatment group were administered intravenously tranexamic acid(TAX)with a loading dose of 20 mg/kg,followed by a continuous infusion of 15 mg/(kg·h),and the control group received equivalent volume of saline until the end of the operation.The values of k-Time,MA,and r-Time in TEG were recorded at four time points:before the operation(T1),immediately after the opera⁃tion(T2),6 and 24 hours after the operation(T3 and T4).A series of items including chest tube drainage,perioperative transfu⁃sions,related laboratory tests,complications and adverse events were also collected.Results There was no significant difference in preoperative general information and perioperative charactaristics between the two groups.There were significant differences in the val⁃ues of k-Time and MA between the two groups at T2,T3 and T4(P<0.01).There were also significant differences in r-Time at T3 and T4(P<0.05 or 0.01).Compared with control group,the postoperative drainage,red blood cell and plasma transfusion of treat⁃ment group were significantly reduced(P<0.05).However,there were no significant differences in postoperative complications and adverse events between the two groups.Conclusion TEG parameters,showed a significant correlation with postoperative blood loss and transfusions.TAX could significantly decreased the prolongation of r-Time and k-Time,mitigate the decrease of MA,and reduce postoperative bleeding and transfusions without causing major complications.

关 键 词：体外循环 心脏手术 血栓弹力图 抗纤溶治疗 氨甲环酸 血液保护 

分 类 号：R654.2[医药卫生—外科学]