在体外循环中应用氨甲环酸对心脏瓣膜置换术患者的血液保护作用  

The blood protection effect of tranexamic acid in patients of heart valve replacement under cardiopulmonary bypass

作　　者：刘志成 勉玉洁 石佳 Liu Zhicheng;Mian Yujie;Shi Jia(Department of Anesthesiology,the Cardiovascular and Cerebrovascular Hospital of Qinghai Province,Xining 810012,China;Department of Intensive Medicine,the Fourth Peoples Hospital of Qinghai Province,Xining 810OOO,China;Anesthesia Center,Beijing Fuwai Hospital,Beijing 100032,China)

机构地区：[1]青海省心脑血管病专科医院麻醉科,西宁810012 [2]青海省第四人民医院重症医学科,西宁810000 [3]北京阜外医院麻醉中心,100032

出　　处：《中国医师杂志》2020年第12期1844-1848,共5页Journal of Chinese Physician

摘　　要：目的探究在体外循环(CPB)中应用氨甲环酸(TA)对心脏瓣膜置换患者麻醉术中血液保护作用。方法选取2018年6月至2019年6月在青海省心脑血管病专科医院行CPB下心脏瓣膜置换术104例患者作为研究对象,随机数字表法分为TA组和对照组,每组各52例,TA组在.CPB预充液中添加10 mg/kg TA,对照组在相同情况下给予相同体积生理盐水。比较两组患者围手术期相关指标,手术前后不同时间凝血指标、血红蛋白、血红细胞以及红细胞压积、心肌相关血清学指标。结果TA组患者术后引流量与异体输血量显著少于对照组患者(P<0.05);两组患者手术结束时凝血酶原时间(PT)凝血酶时间(TT)与部分活化凝血活酶时间(APTT)显著高于手术前与手术后24 h(P<0.05),纤维蛋白原水平显著低于手术前与手术后24 h(P<0.05),手术结束时与手术后24 h全血血小板计数显著低于手术前,手术后24 h全血血小板计数显著高于手术结束时(P<0.05),TA组患者手术结束时上述指标优于对照组(P<0.05),手术后24 h两组患者上述指标差异无统计学意义(P>0.05);两组患者手术结束时与手术后24 h血红蛋白、血红细胞以及红细胞压积较手术前显著降低(P<0.05),且组内手术结束时.手术后24 h比较差异无统计学意义(P>0.05),TA组患者手术结束时与手术后24 h上述指标低于对照组,差异有统计学意义(P<0.05);两组患者手术结束时与手术后24 h时间点肿瘤坏死因子-α(TNF-α)心肌肌钙蛋白T(cTnT)以及中性粒细胞水平显著高于手术前(P<0.05),手术后24 h上述指标水平显著低于手术结束时(P<0.05),TA组患者手术结束后与手术后24 h时间点上述指标水平显著低于对照组患者(P<0.05)。结论心脏瓣膜置换麻醉术中CPB应用TA可以有效抑制纤溶系统作用,血液保护作用显著,能够减少手术完成后输血量,同时保护患者心肌。Objective To investigate the blood protection effect of tranexarmic acid(TA)in anesthesia of heart valve replacement under cardiopulmonary bypass(CPB).Methods 104 patients who underwent heart valve replacement under CPB in Qinghai Cardiovascular and Cerebrovascular Disease Hospital from June 2018 to June 2019 were selected as the research subjects.They were randomly divided into TA group and control group,52 cases in each group.In TA group,TA(10 mg/kg)was added to CPB priming fluid,and the control group were treated with the same volume of normal saline under the same condition.The perioperative related indexes,coagulation parameters,hemoglobin,red blood cells,hematocrit and cardiac muscle-related serological indexes at different time points before and after surgery were compared between the two groups.Results The postoperative drainage volume and allogeneie blood transfusion volume in TA group were significantly smaller than those in control group(P<0.05).At the end of surgery,the prothrombin time(PT),thrombin time(TT)and activated partial thromboplastin time(APTT)in both groups were significantly longer and fibrinogen levels were significantly lower than those before surgery and at 24 h after surgery(P<0.05).The order of whole blood platelet counts at different time from high to low was as fllows:before surgery,at the end of surgery,at 24 h afer surgery(P<0.05).At the end of surgery,the above indexes in TA group were better than those in control group(P<0.05).At 24 h after surgery,there was no significant diference in the above indexes between the two groups(P>0.05).The hemoglobin,red blood cells and hematocrit in both groups were significantly decreased at the end of surgery and at 24 h after surgery(P<0.05),without significant difference in above indexes between the two groups(P>0.05).At the end of surgery and at 24 h after surgery,the above indexes in TA group were lower than those in control group(P<0.05).At end of surgery and at 24 h after surgery,levels of tumor necrosis factor-α(TNF-α),cardiac troponin

关 键 词：氨甲环酸 心肺转流术 心脏瓣膜置换 血液学试验 

分 类 号：R654.2[医药卫生—外科学]