不同剂量氨甲环酸在体外循环下心脏瓣膜置换治疗患者中血液保护的对比研究  

Comparative Study of Different Doses of Tranexamic Acid for Haemoprotection in Patients Treated with Heart Valve Replacement Under Extracorporeal Circulation

作　　者：刘守印 王润生[1] 吴晓 LIU Shou-yin;WANG Run-sheng;WU Xiao(Department of Cardiac Vascular Surgery,Nanyang No.1 People's Hospital,Nanyang,Henan,473000,China)

机构地区：[1]南阳市第一人民医院心脏大血管外科,河南南阳473000

出　　处：《中国血液流变学杂志》2024年第4期580-583,共4页Chinese Journal of Hemorheology

摘　　要：目的探究不同剂量氨甲环酸在体外循环下心脏瓣膜置换治疗患者中血液保护的应用价值。方法选取2021年1月—2024年3月南阳市第一人民医院收治的92例行体外循环心脏瓣膜置换术患者实施研究,根据氨甲环酸剂量的不同分为A组30例(低剂量组:负荷量为10 mg/kg、维持量为8 mg/(kg•h))、B组30例(中剂量组:负荷量为15 mg/kg、维持量为10 mg/(kg•h))、C组32例(高剂量组:负荷量为30 mg/kg、维持量为12 mg/(kg•h))。对比三组临床指标、引流情况、输血情况以及不良反应发生情况。结果三组手术时间、体外循环时间、阻断时间、回输血量、插管时间、ICU时间及住院时间比较,差异无统计学意义(P>0.05);三组6 h引流量、24 h引流量以及总引流量比较差异无统计学意义(P>0.05);三组红细胞输入量、血浆输入量以及血小板输入量比较,差异无统计学意义(P>0.05);A组(3.33%)不良反应发生率低于B组(23.33%)、C组(24.99%)(P<0.05),B组、C组不良反应发生率比较差异无统计学意义(P>0.05)。结论三种不同剂量的氨甲环酸在体外循环心脏瓣膜置换术患者中的各项临床指标、输血情况比较均无差异,保护效果相近,但低剂量的不良反应发生率显著低于中、高剂量。Objective To investigate the value of different doses of tranexamic acid for haemoprotection in patients treated with heart valve replacement under extracorporeal circulation.Methods 92 patients with extracorporeal circulation heart valve replacement admitted to Nanyang No.1 People's Hospital during the period of January 2021-March 2024 were selected for the study,and were divided into 30 cases in group A(low-dose group:loading volume of 10 mg/kg,maintenance volume of 8 mg/(kg·h)),30 cases in group B(medium-dose group:loading volume of 15 mg/kg,maintenance volume of 10 mg/(kg·h)),and 32 cases in group C(high-dose group:loading volume of 30 mg/kg,maintenance volume of 12 mg/(kg·h)).The clinical indexes,drainage,blood transfusion and the occurrence of adverse reactions were compared among the three groups.Results There was no statistically significant difference in operation time,extracorporeal circulation time,blocking time,transfusion volume,intubation time,ICU time and hospital stay among the three groups(P>0.05).There was no difference in 6 h drainage volume,24 h drainage volume and total drainage volume among the three groups(P>0.05).Comparison of the volume of red blood cell input,plasma input and platelet input had no statistical difference(P>0.05).The incidence of adverse reactions in group A(3.33%)was lower than that in groups B(23.33%)and C(24.99%)(P<0.05).And there was no difference in the comparison of the incidence of adverse reactions in groups B and C(P>0.05).Conclusion Comparison of all clinical indicators and blood transfusion in patients undergoing extracorporeal circulation heart valve replacement with three different doses of tranexamic acid showed no difference,and the protective effect was similar,but the incidence of adverse reactions was significantly lower in the low dose than in the intermediate and high dose.

关 键 词：氨甲环酸 体外循环 心脏瓣膜置换治疗 血液保护 

分 类 号：R654.2[医药卫生—外科学]