川芎嗪对血小板保护的研究

３０例体外循环心脏直视手术患者分三组，观察盐酸川芎嗪及二种给药方式对转流中血小板的保护作用。对照组以生理盐水恒速静滴，观察１组以川芎嗪６ｍｇ／ｋｇ，观察Ⅱ组以川芎嗪３ｍｇ／ｋｇ恒速静滴、另３ｍｇ／ｋｇ预充体外循环机内。结果证实，两个观察组与对照组相比，在血小板计数和聚集功能方面差异非常显著（Ｐ＜０．０１），透射和扫描电镜也证实观察组血小板有较好的形态和超微结构，且川芎嗪给药后血流动力学无显著改变（Ｐ＜０．０５）。     

实验鼠重症急性胰腺炎时奥曲肽对细菌易位影响的质粒标记研究

目的评价奥曲肽对重症急性胰腺炎（ｓｅｖｅｒｅａｃｕｔｅｐａｎｃｒｅａｔｉｔｉｓ,ＳＡＰ）及其细菌易位的治疗作用。方法已定殖含重组质粒的大肠杆菌大鼠８０只随机分为４组,每组２０只。在预防治疗组及其对照组,于诱导ＳＡＰ前先以４μｇ／ｋｇ静脉注射后继以６μｇ·ｋｇ－１·ｈｒ－１灌注１小时奥曲肽。在治疗组及其对照组,于诱导ＳＡＰ后０５小时先静脉注射４μｇ／ｋｇ,以后继续皮下注射８μｇ／ｋｇ,８小时一次共２４小时。２４小时后杀鼠取肠系膜淋巴结及腹水作培养,并用质粒ＤＮＡ分析和抗菌谱对细菌加以鉴定识别。结果在预防治疗组肠系膜淋巴结和腹水细菌易位发生率分别为５５％（１１／２０）和２０％（４／２０）,而在治疗组则分别为４７４％（９／１９）和１５８％（３／１９）,与各自对照组相比,都显著降低（Ｐ＜００５）。预防治疗组和治疗组病死率分别为０％（０／２０）和５％（１／２０）,与其对照组相比,也显著降低（Ｐ＜００５）。结论奥曲肽对ＳＡＰ及其细菌易位有治疗作用     

止血芳酸对体外循环心脏手术中血小板功能的保护作用

目的：研究止血芳酸（ＰＡＭＢＡ）对体外循环心肺转流（ＣＰＢ）心脏手术中血小板功能的保护作用。方法：２２例择期心脏瓣膜置换术患者，随分为两组，观察组于麻醉后切片前经中心静脉给予给予ＰＡＭＢＡ ２０ｍｇ／ｋｇ（其中的４００ｍｇ预充体外循环机内），对照组不给药。在ＣＰＢ前、ＣＰＢ后３０分钟、ＣＰＢ结束、鱼精蛋白中和肝素后２０分钟四个时点检测血小板计数、血小板聚集功能和血小板膜糖蛋白ＧＰＩｂ和ＧＰⅡｂ／Ⅲ     

别嘌呤醇对心瓣膜置换手术中氧自由基生成的影响作用

目的 探讨心瓣膜置换术中氧自由基生成及别嘌呤醇的影响作用。方法 将２２例心瓣膜置换术患者随机分为两组；别嘌呤醇组：１０例，术前３天口服别嘌呤醇，每天１０ｍｇ／ｋｇ，对照组；１２例，未服用嘌呤醇。结果 心瓣膜置换手术心肺转流（ＣＰＢ）期间血浆脂质过氧化物和尿酸含量明显升高（Ｐ〈０．０１），别嘌呤醇组血浆脂质过氧化物和尿酸含量虽然也升高（Ｐ〈０．０５），但显著低于对照组（Ｐ〈０．０５）。结论 心瓣膜置     

氨甲酰血红蛋白在评价血液透析充分性中的意义

目的　评价氨甲酰血红蛋白（ Ｃａｒ Ｈｂ） 在血液透析（ Ｈ Ｄ） 充分性中的意义。方法　用高效液相色谱法测定正常对照组３６ 例,非透析慢性肾功能衰竭５１ 例和 Ｈ Ｄ 患者３０ 例 Ｃａｒ Ｈｂ 含量（ 以每克血红蛋白含氨甲酰缬氨酸微克数,μｇ Ｃ Ｖ／ｇ Ｈｂ 表示） 。 Ｈ Ｄ 组 Ｃａｒ Ｈｂ 含量与尿素清除指数（ Ｋｔ／ Ｖ） 、尿素降低率（ Ｕ Ｒ Ｒ） 、平均时间尿素浓度（ Ｔ Ａ Ｃｕｒｅａ） 和校正蛋白质分解率（ｎ Ｐ Ｃ Ｒ） 作相关分析。结果　与对照组（３００ ±６１） 比较, Ｈ Ｄ 组 Ｃａｒ Ｈｂ 含量（１０２５ ±２８９） 显著升高（ Ｐ＜ ００１） ,但显著低于非透析组（１３９９ ±５２０）（ Ｐ＜ ００１） ; Ｋｔ／ Ｖ≤１１ 组 Ｃａｒ Ｈｂ 显著高于 Ｋｔ／ Ｖ＞ １１ 组［（１３５０ ±３１０）ｖｓ．（８８６±１２０） , Ｐ＜ ００１］ ; Ｃａｒ Ｈｂ 与 Ｋｔ／ Ｖ, Ｕ Ｒ Ｒ 呈负相关,但与 Ｔ Ａ Ｃｕｒｅａ 正相关。当 Ｋｔ／ Ｖ＞ １１ ,ｎ Ｐ Ｃ Ｒ＜ １０ ｇ· Ｋｇ１·ｄ１ 组 Ｃａｒ Ｈｂ 显著高于ｎ Ｐ Ｃ Ｒ≥１０ ｇ· Ｋｇ１·ｄ１ 组［（９６５ ±８３）ｖｓ．（８１５ ±１０４） , Ｐ     

别嘌呤醇对体外循环期间氧自由基及内毒素的影响

选取瓣膜置换术患者２２例分为两组；Ａ组（ｎ＝１０）术前３天口服ＡＬＬＯ每天１０ｍｇ／ｋｇ／；Ｂ组（ｎ＝１２）为对照组。结果表明 Ｂ组血 ＬＰＯ和 ＵＡ在 ＣＰＢ期间均明显升高（Ｐ＜０．０１）和（Ｐ＜０．０５），Ａ组血ＬＰＯ和ＵＡ也升高（Ｐ＜０．０５），但却显著低于Ｂ组（Ｐ＜０．０５）；同时Ｂ组血ＬＰＳ含量在开放主动脉及其后１０’明显升高（Ｐ＜０．０１和Ｐ＜０．００１），而Ａ组血ＬＰＳ含量在ＣＰＢ期间无明显升高。提示ＣＰＢ期间ＯＦＲ及ＬＰＳ含量均升高，ＡＬＬＯ可抑制二者的上升。     

慢性肾功能衰竭血浆P物质,心钠素与肾功能的关系

目的了解慢性肾功能衰竭（ＣＲＦ）患者血浆Ｐ物质（ＳＰ）、心钠素（ＡＮＰ）含量变化与肾功能的关系。方法采用放射免疫分析法检测正常对照组及ＣＲＦ组血液透析前后ＳＰ、ＡＮＰ，同时测定血清肌酐（Ｓｃｒ）。结果（１）透析前ＳＰ显著高于正常对照组（Ｐ＜００１），透析后ＳＰ高于透析前（Ｐ＜００５）；ＳＰ透析前与Ｓｃｒ呈正相关（ｒ＝０６６，Ｐ＜００５），ＳＰ透析后与Ｓｃｒ呈负相关（ｒ＝－０４６，Ｐ＜００５）；（２）透析前ＡＮＰ显著高于对照组（Ｐ＜００１），透析后ＡＮＰ显著低于透析前（Ｐ＜００５），ＡＮＰ透析前后与Ｓｃｒ呈正相关（ｒ＝０８２，Ｐ＜００５）；（３）透析前后ＳＰ变化值与ＡＮＰ变化值呈负相关（ｒ＝－０４８，Ｐ＜００５）。结论ＣＲＦ患者血浆ＳＰ、ＡＮＰ含量的变化与肾功能的改变有较明显的相关性。     

心脏瓣膜置换术中血花生四烯酸及其代谢酶的变化

观察了１５例患者体外循环心脏瓣膜置换术中血花生四烯酸（ＡＡ）浓度、血小板膜磷脂酶Ａ２（ＰＬＡ２）、环氧化酶（ＰＣＯ）及脂氧化酶（ＰＬＯ）活性的变化。结果表明：肝素化时血ＡＡ浓度开始增加，但与ＡＡ有关的代谢酶无明显变化；转流开始后，ＡＡ浓度迅速上升，并持续在较高水平（Ｐ＜０．０１），血小板膜ＰＬＡ２、ＰＣＯ、ＰＬＯ活性均明显增加，且随转流时间延长呈逐渐升高趋势（Ｐ＜０．０５及Ｐ＜０．０１），与文献报道的ＡＡ代谢产物升高时限相符。提示：体外循环瓣膜置换术中ＡＡ代谢明显变化，但转流前与转流中ＡＡ代谢的途径及变化程度具有差异。     

甘露醇治疗大鼠急性出血坏死性胰腺炎的实验观察

为观察自由基清除剂甘露醇对急性出血坏死性胰腺炎（ＡＨＮＰ）的治疗作用，在２８只Ｗｉｓｔａｒ大鼠胰管内逆行注入牛胆汁酸钠，造成ＡＨＮＰ模型后随机分成治疗组和对照组。治疗组大鼠以２０％甘露醇（１ｇ／ｋｇ）于尾静脉缓慢推注，１次／１２小时，直至实验结束。对照组以同样方法及间隔时间给予生理盐水（５．０ｍｌ／ｋｇ）。两组大鼠均于９６小时采心脏血后处死。结果：治疗组胰腺组织中过氧化脂质（ＬＰＯ）、血清中ＬＰＯ、乳酸脱氢酶（ＬＤＨ）、α１抗胰蛋白酶（α１ＡＴ）、谷草转氨酶（ＧＯＴ）和胰腺组织坏死面积均显著低于对照组（Ｐ＜０．０１或Ｐ＜０．０５）。光镜下治疗组胰腺、肝脏、心脏、肾脏的损害亦轻于对照组。治疗组大鼠死亡率显著低于对照组（Ｐ＜０．０５）。由此表明：甘露醇能够清除自由基，减轻ＡＨＮＰ胰腺及其全身脏器的损害     

氨甲苯酸和抑肽酶对体外循环中肝素抗凝作用的影响

目的为探讨氨甲苯酸和抑肽酶的止血疗效。方法将３４例成人心脏手术患者分为３组，Ａ组于体外循环（ＣＰＢ）前、中、后给予氨甲苯酸共７５０ｍｇ；Ｂ组ＣＰＢ中给予抑肽酶２００万Ｕ；并设一对照组。结果氨甲苯酸使ＣＰＢ中激活全血凝固时间（ＡＣＴ）明显缩短，追加肝素量较另两组显著增加（Ｐ＜０．０５），２４小时胸液量较对照组减少２３％（Ｐ＞０．０５）。抑肽酶使ＣＰＢ中ＡＣＴ略延长，与对照组相比无统计学意义，对肝素用量无影响，２４小时胸液减少３５％（Ｐ＜０．０５）。两用药组术中术后库血用量均显著减少（Ｐ＜０．０１），术后胸液量相似（Ｐ＞０．０５）。结论氨甲苯酸止血疗效弱并缩短ＡＣＴ及明显增加肝素用量，不如抑肽酶疗效可靠。     

Tranexamic acid in aortic valve replacement.

OBJECTIVE: To assess the relative efficacy of tranexamic acid compared with a control group to decrease bleeding and transfusion requirements in a uniform population undergoing aortic valve replacement. DESIGN: Prospective, randomized, double-blind study. SETTINGS: University hospital. PARTICIPANTS: Adult cardiac surgery patients (n = 300). INTERVENTIONS: Patients were randomized into 2 groups to receive either a total of 5 g of tranexamic acid or a saline solution. Bleeding in the postoperative period, transfusions of bank blood products, coagulation profile, intensive care unit stay, and hospital length of stay were recorded. MEASUREMENTS AND MAIN RESULTS: Postoperative bleeding in patients treated with tranexamic acid was significantly lower compared with the control group (p < 0.0001). Packed red blood cells and fresh frozen plasma usage were reduced in the tranexamic acid group compared with the control group (p = 0.0095 and p < 0.0001). Only 24.5% of tranexamic acid patients received blood products versus 45% of control patients (p < 0.01). There was no significant difference in hematologic and coagulation profiles after the operation between the groups. CONCLUSIONS: Tranexamic acid reduces postoperative blood loss and transfusion requirements in elective aortic valve replacement.     

微创体外循环对冠状动脉旁路移植术患者围手术期血液保护的临床研究

目的 研究微创体外循环(MECC)对心脏手术围手术期血液保护的临床效果.方法 回顾性分析2006年8月至2009年10月接受择期单纯冠状动脉旁路移植手术(CABG)的120例患者的临床资料,按其辅助循环方式分为MECC组、传统体外循环(Cecc)组和非体外循环(off-pump)组,每组40例.除常规的体外循环方法外,MECC组采用Jostra MECC系统,Cecc组采用浅低温体外循环.收集患者围手术期凝血功能和血液细胞学检查结果、血液制品用量和术后24 h引流量进行统计分析.结果 EuroSCORE术前风险及预期病死率评估MECC组均高于Cecc组和off-pump组(P＜0.01).off-pump组手术时间和远端吻合口数量均低于MECC组和Cecc组(P＜0.05),MECC组和Cecc组间无差别.比较术后各组内源性凝血功能(活化部分凝血活酶时间),Cecc组在转后早期明显较正常值延长,并在转后2 h、6 h、12 h明显高于MECC组和off-pump组(P＜0.05);而外源性凝血功能(凝血酶原时间)三组间没有差别.MECC组和Cecc组患者校正后的血浆游离血红蛋白均在转中明显升高并在停机时达到高峰,转后24 h左右下降至转前水平;但Cecc组均高于MECC组(P＜0.05).Cecc组术后第1个24 h人均胸腔纵隔引流量高于MECC组和off-pump组(P＜0.05).虽然Cecc组血小板计数术中和术终平均值较低,且人均围手术期使用血液制品量较高,但三组间差异没有统计学意义.结论 MECC可以减少常规体外循环过程对血液成分破坏和对凝血功能的干扰,减少术后胸腔纵隔引流量,降低心脏手术对异体血液制品的需求.

Abstract：

Objective To analyze the clinical effect of minimal extracorporeal circulation (MECC)in blood conservation perioperatively coronary artery bypass graft (CABG). Methods The data of 120 cases received simple CABG since August 2006 to October 2009 was analyzed retrospectively. All the patients were divided to three groups according to the mode of circulation support in-operation: MECC, conventional extracorporeal circulation (cECC) or off-pump, 40 cases in each group. Jostra MECC system with normal temperature was used in MECC group, and common membrane oxygenator with moderate hypo-temperature was used in cECC group. Collect the data of coagulation and the blood cytological examination perioperatively, the draining volume during the first 24 h after operation, and consumption of blood products perioperatively. Results Stardard and logistic EuroSCORE were higher in MECC group than the others (P＜0.01). The operative time and the number of distal anastomosis of off-pump group were less than MECC and cECC groups (P ＜ 0. 05 ), while no difference between MECC group and cECC group. Intrinsic coagulation (activated partial thromboplastin time) were much more prolonged early postoperatively in cECC group, and higher than in MECC group and off-pump group at 2 h, 6 h and 12 h postoperatively (P ＜0. 05), but no difference in extrinsic coagulation (prothrombin time ) among three group. Adjusted by hematocrit of the same sample, free hemoglobin level rose up during the ECC procedure and reached the maxlmum at the end of ECC in cECC group and MECC group, but the levels were more higher in cECC group than in MECC group (P < 0. 05 ). The draining volum during the first 24 h after operation of cECC group was larger than MECC group and off-pump group (P < 0. 05 ). Although the decreased platelet count perioperatively and more consumed of the blood products in cECC group, but no difference among the three groups. Conculsion MECC could reduce the ruin to blood cell and interfere to coagulation function during the conventional ECC procedure, decrease the postoperative draining volum and requirement of blood products.     

Hemostatic changes after artificial valve replacement--especially tricuspid regurgitation

To investigate hemostatic changes after artificial valve replacement, I studied platelets, fibrinogen (Fbg), antithrombin III (AT-III), fibrinogen degradation products (FDP), thrombotest (TT), prothrombin time (PT), bleeding time (BT) and activated partial thromboplastin time (APTT) in 75 patients complicated with combined cardiac valvular disease. Twenty-nine patients with tricuspid regurgitation (TR group) and 46 patients without that (control group) were compared. 1) TR group, that contained patients with severer cases, showed a significantly longer operative time and greater bleeding volume than control group (p less than 0.01). 2) Many patients in TR group showed high serum II, frequency of abnormal platelet functions during and after extracorporeal circulation total-bilirubin and GPT level after operation and higher ICG R-value before operation than in control group. 3) After operation, the platelet count was significantly lower in TR group (p less than 0.01) than in control group, and was lowest on the 3rd postoperative day in both groups. 4) In both groups Fbg increased significantly after operation, and was lower in TR group on the 7th and 10th postoperative days than in control group. FDP was significantly higher in TR group than in control group after the 3rd postoperative day. 5) BT and APTT were similar in the two groups. 6) PT and TT were lower in TR group before operation (p less than 0.01) than in control group, and decreased after operation and administration of anticoagulants in both groups. These results indicate that patients with combined cardiac valvular disease with tricuspid regurgitation have a hemorrhagic tendency due to disorders of extrinsic coagulant, which may be caused by liver hypofunction, and are easy to bleed.     

Comparative evaluation of the effects of tranexamic acid and low-dose aprotinin on post-valvular heart surgery bleeding and allogenic transfusion

Bleeding diathesis and allogenic transfusion after complex heart surgery, such as heart valve surgery, may result in complications such as transfusion reaction, viral infection, postoperative infection, haemodynamic disturbance, prolonged stay in the intensive care unit and hospital, renal and respiratory failure and mortality. In this prospective, double-blind, randomized, placebo-controlled clinical trial, 90 patients were randomly divided into three groups: aprotinin, tranexamic acid and control. Chest-tube drainage, transfusion requirements and renal and neurological complications were evaluated. We found that chest-tube drainage during the first (P < 0.0001) and second 24 h (P = 0.001) after admission to the intensive care unit were significantly lower in the aprotinin group. The amounts of transfused packed red blood cells (P < 0.0001) and platelets (P = 0.02) were significantly lower in the aprotinin and tranexamic acid groups. The quantity of transfused fresh frozen plasma (P = 0.034) was significantly lower in the aprotinin group only. We did not find any neurological complications or renal failure in the three groups. Our data suggest that in valvular heart surgery, low-dose aprotinin is significantly better than tranexamic acid or a placebo for reduction of postoperative bleeding and allogenic transfusion, without increasing adverse outcomes.     

心脏瓣膜置换患者围手术期加速康复外科护理

目的探索加速康复外科护理应用于心脏瓣膜置换患者围手术期的效果。方法将2015年1~12月行低温体外循环下瓣膜置换术患者37例作为对照组,给予常规心外科治疗与护理;2016年1~12月行相同手术的患者39例作为观察组,应用加速康复外科护理进行围手术期管理。结果观察组术后腹胀、切口感染、肺部感染发生率显著低于对照组,术后首次下床时间、ICU观察时间及住院时间显著短于对照组,且住院费用显著少于对照组(P0.05,P0.01);观察组出院时满意度显著高于对照组(P0.05)。结论心脏瓣膜置换患者围手术期实施加速康复外科护理,可有效促进患者术后康复,减少术后并发症,缩短患者住院时间,降低住院费用,从而提升患者满意度。     

心脏瓣膜置换手术死亡风险模型与体外膜肺氧合代替体外循环的适应证探讨

目的 建立心脏瓣膜病术前评估的死亡风险模型,并对手术病人进行评估,对体外膜肺氧合(ECMO)代体外循环的适应证进行初步探讨.方法 对4482例心脏瓣膜置换手术病人进行回顾性分析,选取性别,年龄,术前左心室射血分数(EF)、左心室舒张末径、肺动脉压、肾功能和是否合并冠心病7个临床指标作为住院死亡的可能影响因素.利用单因素分析进行筛选,用多因素Logistic回归确立死亡风险模型.根据模型,对此后的瓣膜病病人术前进行死亡风险评估,死亡概率≥10%的病例,随机分别给予常规手术或ECMO代替体外循环、术后转为心肺辅助.比较两种方法的手术病死率.采用SPSS11.5统计软件进行检验(α=0.05).结果 单因素分析除性别之外,其余6个因素均有统计学意义.Logistic回归建立死亡风险模型为Ln(P/1-P)=-4.3742+0.5192肾功能+0.1467年龄+0.3947EF+0.9390冠心病+0.5888肺动脉压+0.3287左室舒末径.此后常规手术52例,ECMO代体外循环术后转心肺辅助22例,两组性别、年龄、预计病死率构成比差异无统计学意义.两组预计病死率分别为(16.35±4.3)%和(16.21±5.19)%,差异无统计学意义(P<0.05).实际病死率分别为30.76%(16/52例)和9.09%(2/22例),差异有统计学意义(Pearson Chi-Square,P=0.047).结论 心脏瓣膜置换术前死亡风险评估,高龄、左心室低EF值、左室舒张末径过大或过小、肺动脉高压、肾功能不良、合并冠心病是危险因素,可以计算预计确切死亡概率.利用心脏瓣膜病死亡风险模型,对高风险(10%以上)病人进行ECMO代体外循环、术后转为心肺辅助,有利于降低手术病死率.     

Use of tranexamic acid for an effective blood conservation strategy after total knee arthroplasty

We have investigated the effect of treatment with tranexamic acid, an inhibitor of fibrinolysis, on blood loss, blood transfusion requirements and blood coagulation in a randomized, double-blind, placebo-controlled study of 42 patients after total knee arthroplasty. Tranexamic acid 15 mg kg-1 (n = 21) or an equivalent volume of normal saline (n = 21) was given 30 min before surgery and subsequently every 8 h for 3 days. Coagulation and fibrinolysis values, blood loss and blood units administered were measured before administration of tranexamic acid, 8 h after the end of surgery and at 24 and 72 h after operation. Coagulation profile was examined (bleeding time, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), plasminogen, beta-thromboglobulin and fibrinogen). Fibrinolysis was evaluated by measurement of concentrations of D-dimer and fibrinogen degradation products (FDP). Total blood loss in the tranexamic acid group was 678 (SD 352) ml compared with 1419 (607) ml in the control group (P < 0.001), and occurred primarily during the first 24 h after surgery. Thirteen patients received 1-5 u. of packed red blood cells in the control group compared with two patients in the tranexamic acid group, who received 3 u. (P < 0.001). Postoperative packed cell volume values were higher in the tranexamic acid group despite fewer blood transfusions. Postoperative concentrations of plasminogen were decreased significantly in the tranexamic acid group (P < 0.001). Platelet count, PT, aPTT, bleeding time, beta- thromboglobulin, fibrinogen and FDP concentrations did not differ between groups, but D-dimer concentrations were increased in the control group. Thromboembolic complications occurred in two patients in the control group compared with none in the tranexamic acid group.      

Effect of tranexamic acid on postoperative bleeding in pediatric heart surgery

OBJECTIVE: To assess the effects of a single dose of tranexamic acid on bleeding and requirement for blood product transfusion in children undergoing cardiac surgery with cardiopulmonary bypass. PATIENTS AND METHODS: A prospective study of closed cohorts undergoing pediatric heart surgery was carried out. The children weighed between 4 and 10 kg. Reoperated and cyanotic patients were included in the sample. The treatment group received 50 mg x kg(-1) of tranexamic acid before surgery. Analyzed data collected during the first 24 hours after surgery were biochemical parameters, bleeding, use of blood products, and D-dimer levels. RESULTS: Fifty-three patients, 25 in the treatment group, were enrolled. Patients on treatment had 24.8% less bleeding in the first 24 hours after surgery (P = .02). The transfusion of blood products was 20% less in the treatment group, although the difference was not significant except in the subgroup of patients who were reoperated. In that group the amount of blood products transfused was 72% less than in the control group (P = .05). D-dimer levels were also lower in the treatment group (P = .003). No adverse effects attributable to the treatment were observed. CONCLUSIONS: A single preoperative dose of tranexamic acid to inhibit fibrinolysis reduces bleeding 24.8% in pediatric patients undergoing heart surgery with cardiopulmonary bypass. The effect is greater in reoperated patients, leading to a reduction in their requirement for transfusion. The use of this therapy in these patients is therefore highly justified.     

心脏基础液在心脏瓣膜置换术后的应用

目的探讨心瓣膜置换术后应用心脏基础液补充钾、镁和保护心肌细胞的作用。方法９２例心脏瓣膜置换术后患者随机分为２组：对照组４９例和基础液组４３例。２组于手术结束后,分别应用极化液和心脏基础液于１８小时、４８小时和７２小时时查血钾、血镁和心肌酶。结果基础液组比对照组血钾、血镁明显升高且稳定（Ｐ＜０．０５）,其心肌酶亦比对照组明显下降（Ｐ＜０．０１）。结论在心瓣膜置换术后应用基础液能稳定地补充血钾、血镁及保护心肌细胞     

Topical use of tranexamic acid in coronary artery bypass operations: a double-blind, prospective, randomized, placebo-controlled study

OBJECTIVES: We sought to investigate the effect of topical application of tranexamic acid into the pericardial cavity in reducing postoperative blood loss in coronary artery surgery. METHODS: A prospective, randomized, double-blind investigation with parallel groups was performed. Forty consecutive patients undergoing primary coronary surgery were randomly assigned to group 1 (tranexamic acid group) or group 2 (placebo group). Tranexamic acid (1 g in 100 mL of saline solution) or placebo was poured into the pericardial cavity and over the mediastinal tissues before sternal closure. The drainage of mediastinal blood was measured hourly. RESULTS: Chest tube drainage in the first 24 hours was 485 +/- 166 mL in the tranexamic acid group and 641 +/- 184 mL in the placebo group (P =.01). Total postoperative blood loss was 573 +/- 164 mL and 739 +/- 228 mL, respectively (P =.01). The use of banked donor blood products was not significantly different between the two groups. Tranexamic acid could not be detected in any of the blood samples blindly collected from 24 patients to verify whether any systemic absorption of the drug occurred. There were no deaths in either group. None of the patients required reoperation for bleeding. CONCLUSIONS: Topical application of tranexamic acid into the pericardial cavity after cardiopulmonary bypass in patients undergoing primary coronary bypass operations significantly reduces postoperative bleeding. Further studies must be carried out to clarify whether a more pronounced effect on both bleeding and blood products requirement might be seen in procedures with a higher risk of bleeding.