不同剂量氨甲环酸对心脏瓣膜术患者血液的保护作用

目的比较低、中、高三种不同剂量氨甲环酸对心脏瓣膜手术患者的血液保护效果。方法2009年2月至2010年2月，择期行心脏瓣膜手术患者150例，随机分成3组：低剂量组（n=49），负荷量10m／kg，维持量2mg／（1kg·h）；中剂量组（n=51），负荷剂量为15mg／kg，维持量为8mg／（kg·h）；高剂量组（n=50），负荷剂量为30mg／kg，维持量为16mg／（kg·h）。记录术后胸管引流量，红细胞、血浆、血小板的使用情况，以及住院死亡和并发症发生率。结果低、中、高三组患者术后6h引流量[（324．90±196．05）vs．（303．73±185．03）vs．（255．31±121．81）ml]、24h引流量[（611．67±281．56）vs．（601．50±304．33）vs．（555．82±239．16）ml]和总引流量[（744．48±350．90）V8．（712．20±359．15）vs．（658．67±290．07）ml]比较差异均无统计学意义（P〉0．05）。三种剂量下，异体红细胞、新鲜冰冻血浆、血小板的使用率及使用量亦无统计学差异（P〉0．05）。三组患者并发症发生率无统计学意义（P〉0．05）。结论低、中、高三种剂量的氨甲环酸对瓣膜手术患者术后出血、输血及术后并发症的影响无显著差异，术中推荐应用低剂量。

Comparison of blood-saving effects of different dose of tranexamic acid in cardiac valvular surgery

Objective To compare the blood - saving effect of different dose of tranexamic acid in cardiac valvular surgery. Methods From February 2009 to February 2010, one hundred and fifty patients were randomly divided into 3 groups according to different dose of tranexamic acid in cardiac valvular surgery： low dose group （n =49）, the loading dose was 10 mg,/kg and maintenance dose was 2 mg/（kg · h） ; moderate dose group （n =51） , the loading dose was 15 mg/kg and maintenance dose was 8 mg/（kg ·h） ; high dose group （n =50）, the loading dose was 30 mg/kg and maintenance dose was 16 mg/（kg ·h）. The bolus of tranexamic acid was infused intravenously within 30 min after induction followed by continuous infusion until the end of operation. The volume of chest tube drainage was recorded at 6 h and 24 h after operation. The total volume was calculated. The requirement for transfusion of allogeneic red blood cells （RBC）, platelet （Pit） and fresh frozen plasma （FFP） were also recorded. Results There were no significant differences in the volume of chest tube drainage at 6 h （ （ 324.90 ± 196.05 ） vs. （ 303.73 ± 185.03 ） vs. （ 255.31 ± 121.81 ） ml）, 24 h （（611.67 ±281.56） vs. （601.50 ±304.33） vs. （555.82 ±239.16） ml） and the total volume（（744.48 ±350.90） vs. （712.20 ± 359.15 ） vs. （658.67 ±290.07） ml） after operation （ P 〉0.05）. Moreover, the requirements for transfusion of allogeneic RBC, Pit and FFP were not significantly different （ P 〉 0. 05 ）. No fatalities occurred during the hospital stay in any of the 3 groups. Conclusion There are no significant differences in transfusion and chest tube drainage in the 3 different dose groups. Therefore, low dose of tranexamic acid is recommended for blood - saving in cardiac valvular surgery.