氨甲环酸与抑肽酶对血液保护功能的对比研究

目的　比较氨甲环酸(TA)与抑肽酶(AP)对体外循环术中血液保护功能的影响,探讨其机制。方法　选取体外循环心脏手术病人 82例,随机分为氨甲环酸用药组、抑肽酶用药组和对照组。TA组总量 1. 5g,于麻醉诱导后切皮前及体外循环开始后两个时间点各给半量,一次性静脉推注;AP组 500万KIU同TA组两个时间点半量分次持续滴注给药,对照组不用药。于术前、后分别测定血小板数量与功能、平均血小板体积、凝血三项、D-二聚体,记录各组术中出血量、术后 12h、24h纵隔心包引流量及术后输血量。结果　AP组与TA组较空白对照组在术前后血小板数量功能变化、D-dimer值及术后引流量、输血量这些方面均有显著性差异 (P<0. 05),而AP组与TA组在此方面的数值差异均无统计学意义。结论　本实验证明了氨甲环酸在体外循环中作用近似抑肽酶,除明显抑制术中体内纤溶系统激活外,在减少术后血小板数目和功能的减低方面发挥了作用。另外两药均可明显减少术后的引流量、全血及成分血的输入量。

Control Study on The Blood Conservation of Tranexamic Acid and Aprotinin

OBJECTIVE To compared tranexamic acid with aprotinin on their platelet conservation function and explore their mechanisim.METHODS 82 adult patients,underwent valve replacement and coronary revascularisations, were randomized into AP , TA and control groups.30 patients received TA(total 1.5g),36 patients received AP(total 700mg). Medication was given before skin incision and added to CPB circuit.The platelet count,MPV,PAdT,PT,APTT,FIB,D-dimers were evaluated. The intraoperative blood loss,the postoperative mediastinal chest tube drainage (MCTD) during 12 and 24 hours, postoperative blood product transfusions were all recorded.RESULTS Both aprotinin and tranexamic acid provided significant changes in platelet count,PAdT,D-dimer and the postoperative MCTD and transfusion(P<0.05). But all the data doesn't show any statistically differences between the aprotinin and tranexamic acid group.CONCLUSION Tranexamic acid is as effective as aprotinin in antifibrinolysis, conservation of platelet function, reduction of postoperative MCTD and transfusion in patients undergoing cardiac surgery.