不同剂量氨基己酸对婴幼儿腭裂修复术围术期创面出血的影响  

Effect of different doses ofε-aminohexanoic acid on perioperative wound bleeding in infants with cleft palate repair

作　　者：余高锋 陈柳妹 金赛芬 彭亮明 陈亦阳 侯劲松[3] Yu Gaofeng;Chen Liumei;Jin Saifen;Peng Liangming;Chen Yiyang;Hou Jinsong(Department of Anesthesiology,Guangzhou Women and Children’s Medical Center,Guangzhou 510623,China)

机构地区：[1]广州市妇女儿童医疗中心麻醉科,广州510620 [2]广州市妇女儿童医疗中心口腔科,广州510620 [3]中山大学附属口腔医院,广州510095

出　　处：《新医学》2023年第4期261-265,共5页Journal of New Medicine

基　　金：广东省口腔医学重点实验室开放课题基金“光华口腔专科联盟”专项项目(KF2020110102)。

摘　　要：目的探讨不同剂量氨基己酸(EACA)对婴幼儿腭裂修复术患者创面出血的影响。方法选取择期接受腭裂修复术的120例患儿,年龄6~36个月,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,将其随机分为常规剂量组(E1组)、低剂量组(E2组)和对照组(C组),每组40例。E1、E2组患儿切皮前开始给予负荷剂量EACA 40 mg/kg、20 min,维持量分别为30 mg/(kg·h)和10 mg/(kg·h),C组患儿输注相应剂量生理盐水。3组患儿的麻醉方案相同,比较其术中、拔管前和术后24 h创面出血评分、术中出血量、麻醉时间、手术时间、术前及术后24 h纤维蛋白原浓度以及延迟出血、深静脉血栓和癫痫的发生情况。结果与C组比较,E1、E2组术中和气管拔管前创面出血评分降低,术中出血量减少,术后24 h纤维蛋白原浓度升高(P均<0.05);E1、E2组间比较则差异无统计学意义(P均>0.05)。3组间手术时间、麻醉时间、术后延迟出血等情况比较差异无统计学意义(P均>0.05)。3组患儿均未出现术后深静脉血栓和癫痫。结论EACA可改善婴幼儿腭裂修复术围术期创面出血情况,降低创面延迟出血的发生率,低剂量EACA的止血效果良好,可为临床用药提供参考。Objective To observe the effect of different doses ofε-aminocaproic acid(EACA)on wound bleeding in infants undergoing cleft palate repair.Methods One hundred and twenty infants scheduled to undergo cleft palate repair,aged from 6 to 36 months,ASA statusⅠorⅡ,were randomly divided into the control(group C),conventional-dose EACA(group E1)and low-dose EACA groups(group E2),40 cases in each group.Infants in groups E1 and E2 were administrated with a loading dose of EACA(40 mg/kg)for 20 min before incision,followed by continuous infusion of 30 mg/(kg·h)and 10 mg/(kg·h)in two groups,respectively.In group C,continuous infusion of normal saline was applied.Same anesthesia regimen was delivered for all patients among three groups.Wound bleeding scores during operation,before extubation and 24 h after operation,intraoperative blood loss,anesthesia time,operation time,and fibrinogen concentration before and 24 h after surgery,and the incidence of delayed haemorrhage,deep vein thrombosis and epilepsy were recorded.Results Compared with group C,the wound bleeding scores during operation and before extubation in group E1 and E2 were significantly lower,the amount of intraoperative blood loss was significantly less,and the fibrinogen concentration at postoperative 24 h was significantly increased(all P<0.05),while no significant statistical difference was observed between groups E1 and E2(all P>0.05).There were no statistically significant differences in operation time,anesthesia time and the incidence of delayed hemorrhage among three groups(all P>0.05).No deep vein thrombosis or epilepsy occurred among three groups.Conclusion The application of EACA in infants with cleft palate repair can mitigate perioperative wound bleeding and lower the incidence of delayed hemorrhage.Low-dose EACA yields favorable hemostatic effect.These findings provide reference for drug use in clinical practice.

关 键 词：腭裂修复术 婴幼儿 创面出血 氨基己酸 术中出血 延迟出血 

分 类 号：R782.2[医药卫生—口腔医学]