心脏手术中抗纤溶药物的临床应用进展

心脏手术中过度失血仍是心脏手术面临的的主要挑战之一,抗纤溶药物的临床应用为解决这一难题带来希望。由于抑肽酶可增加肾损伤、增加术后死亡率,赖氨酸类似物成为心脏手术中主要抗纤溶用药,其中氨甲环酸的应用最为广泛。无论是在体外循环心脏手术还是在非体外循环冠状动脉搭桥手术中,氨甲环酸的有效性经多项研究证实。而如今,不同出血风险的心脏手术中氨甲环酸的应用剂量仍未明确。在氨甲环酸广泛应用的同时,其安全性也引起大家质疑,其与术后谵妄的关系也引起大家高度注意,而有专家呼吁抑肽酶有必要再次进入临床。将来,抑肽酶是否会成为高危出血心脏手术中的主要抗纤溶用药,氨甲环酸的合理应用剂量最终怎样界定,对这些问题我们拭目以待。

The Clinical Application of Anti-fibrinolytic Drug in Cardiac Surgery

Postoperative massive bleeding is still a great challenge for cardiac surgery. Anti-fibrinolytic drug brings hope for solving this problem. As the risk of aprotinin increases renal dysfunction and mortality, tranexamic acid has taken the forefront and has become the first choice of antifibrinolytic agent for cardiac surgery in many countries, including U.S. and China. The effective of blood conservation was demonstrated in both cardiac surgeries with and without cardiopulmonary bypass. However, the optimal tranexamic acid dose regimen to achieve and sustain steady therapeutic blood concentration is still under heated debate. Moreover, recent studies implied that high dose tranexamic acid was a possible cause for postoperative seizures following cardiac surgery. It need further study to definite the reasonable dose regimen of tranexamic acid and to kown if aprotinin will come back to the clinical application.