止血环酸在心肺转流术中对凝血功能的影响  

Effect of tranexamic acid on hemostasis system during cardiac surgery under cardiopulmonary bypass

作　　者：张富军[1] 徐美英[1] 杜建儿[1] 朱文忠[1] 周宁 

机构地区：[1]第二军医大学附属长海医院麻醉科 [2]南京第四五四医院麻醉科

出　　处：《临床麻醉学杂志》2004年第4期216-218,共3页Journal of Clinical Anesthesiology

摘　　要：目的 应用sonoclot分析仪(SCT)观察止血环酸在心脏手术中的血液保护效果。方法36例心脏手术患者分成工组(抑肽酶,n=12)、Ⅱ组(止血环酸,n=12)和Ⅲ组(非用药组,n=12)。Ⅰ、Ⅱ组在心肺转流(CPB)下完成心脏手术,Ⅲ组则为非CPB下的冠脉搭桥手术。应用SCT观察切皮前和鱼精蛋白中和肝素后的凝血和血小板(Plt)功能的变化。结果 sonACT在T_1时点Ⅲ组为(123.21±18.58)s,明显高于Ⅰ组的(110.36±24.72)s和Ⅱ组的(106.09±13.91)s(P均<0.05);纤维蛋白凝集率(clot rate)、Plt功能在T_1与T_2时点三组之间均无显著差异。Plt在T_2时点Ⅲ组则明显高于Ⅰ、Ⅱ组。Ⅰ、Ⅱ组在T_2时点的Plt较T_1下降非常显著(P<0.01),Ⅲ组则无明显改变。结论 止血环酸对CPB下心脏手术患者凝血与Plt功能的影响与抑肽酶相似,非CPB下冠状动脉搭桥术对血液系统的影响明显减轻。Objective To observe the preservation of hemostatic system using tranexamic acid by sonoclot(SCT) coagulation and platelet function analyzer during cardiac surgery under cardiopulmanary bypass(CPB). Methods 36 patients undergoing heart operation were divided into aprotinin (group Ⅰ,n=12) ,tranexamic acid(group Ⅱ,n=12)and control(group Ⅲ,n=12). The procedures of group Ⅰ and group Ⅱ were performed under CPB,and of group Ⅲ off-pump coronary artery bypass grafting(OPCAB). Coagulation and platelet function were determined by SCT at the points of pre-incision(T_1) and post-heparin reversal with protamin(T_2). Results sonACT of group Ⅲ at T_1(123.21±18.58) s was obviously higher than that of group Ⅰ(110.36±24.72) s and group Ⅱ(105.09±13.91) s. There were no significant differences in clotrate and platelet function at T_1 and T_2 among three groups. Platelet counts of group Ⅲ at T_2 were significantly higher than those of group Ⅰ and group Ⅱ. Platelet counts of group Ⅰ and group Ⅱ at T_2 reduced significantly than those at T_1,and there was no any change obviously in group Ⅲ. Conclusion Effect of tranexamic acid on hemostatic system during cardiac surgery under cardiopulmonary bypass is the same as that of aprotinin, and the effect of OPCAB on hemostatic system is reduced greatly.

关 键 词：止血环酸 心肺转流术 凝血功能 心脏手术 

分 类 号：R654.2[医药卫生—外科学]