不同剂量氨甲环酸对心脏外科手术后下肢深静脉血栓的影响  

Effects of Different Doses of Tranexamic Acid on Deep Vein Thrombosis of Lower Limb after Cardiac Surgery

作　　者：刘岳 张世杰 袁峻伟[3] 李倩[1] 吕红[1] 石佳[1] LIU Yue;ZHANG Shi-jie;YUAN Jun-wei;LI Qian;LYU Hong;SHI Jia(Department of Anesthesiology,Fiwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Anesthesiology,Wu'an First People's Hospital,Wu'an 056300,China;Center of Stomatology,Peking University Hospital,Beijing 100871,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,北京市100037 [2]武安市第一人民医院麻醉科,武安市056300 [3]北京大学医院口腔中心,北京市100871

出　　处：《中国分子心脏病学杂志》2021年第5期4218-4222,共5页Molecular Cardiology of China

摘　　要：目的评估不同剂量氨甲环酸对体外循环心脏外科手术后新发下肢深静脉血栓发生率的影响。方法采用回顾性队列研究的方法,选取2017年—2019年接受体外循环心脏外科手术的患者共计237例,根据术中使用氨甲环酸剂量的大小分为低剂量组[0mg/kg<负荷量≤10mg/kg,0mg/(kg·h)<维持量≤10mg/(kg·h),80例]、中剂量组[10mg/kg<负荷量≤20mg/kg,10mg/(kg·h)<维持量≤15mg/(kg·h),78例]和高剂量组(20mg/kg<负荷量≤30mg/kg,15mg/(kg·h)<维持量≤20mg/(kg·h),79例)。观察术后下肢深静脉血栓的发生率及凝血功能指标、总引流量、异体血制品输注情况、各类不良事件的发生率和死亡率。结果三组患者在人口统计学基线资料、术前凝血功能的差异均无统计学意义(P>0.05)。三组患者术后新发下肢深静脉血栓发生率的差异无统计学意义(P>0.05)。术后凝血功能指标中,除D-二聚体水平高剂量组分别显著低于其他两组(P<0.05),其余指标在三组间的差异均无统计学意义(均P>0.05)。结论下肢深静脉血栓的发生率不随氨甲环酸剂量的增加而升高。Objective To evaluate the effect of different doses of tranexamic acid on the incidence of post-operative lower extremity deep vein thrombosis in cardiac surgery with extracorporeal circulation.Methods A total of 237 patients who underwent cardiac surgery with extracorporeal circulation at Fuwai Hospital from 2017 to 2019 were selected and categorized into low-dose group(0 mg/kg<loading dose≤10 mg/kg,0 mg·kg^(-1)·h^(-1)<maintenance dose≤10 mg·kg^(-1)·h^(-1),n=80),medium-dose group(10 mg/kg<loading dose≤20 mg/kg,10 mg·kg^(-1)·h^(-1)<maintenance dose≤15 mg·kg^(-1)·h^(-1),n=78)and highdose group(20 mg/kg<loading dose≤30 mg/kg,15 mg·kg^(-1)·h^(-1)<maintenance dose≤20 mg·kg^(-1)·h^(-1),n=79).The incidence of post-operative lower limb deep vein thrombosis and coagulation function indices,total drainage,allogeneic blood product transfusion,incidence of various adverse events and mortality were analyzed.Results There were no significant differences in demographic data and pre-operative coagulation function between the 3 groups(P>0.05).No statistically significant differences existed in the incidence of new lower limb deep vein thrombosis after surgery between the 3 groups(P>0.05).No statistically significant differences existed in post-operative coagulation function indices among the 3 groups(all P>0.05),except for the D-dimer level in the high-dose group,which was significantly lower than the other two groups,respectively(P<0.05).Conclusion The incidence of lower limb deep vein thrombosis did not increase with the escalation of tranexamic acid dose.

关 键 词：氨甲环酸 下肢深静脉血栓 心脏外科手术 体外循环 

分 类 号：R654.2[医药卫生—外科学]