氨甲环酸对非体外循环冠状动脉旁路移植术病人炎性反应的影响

目的 评价氨甲环酸对非体外循环冠状动脉旁路移植术病人炎性反应的影响.方法 择期行非体外循环冠状动脉旁路移植术的病人60例,年龄45～64岁,体重指数16～ 22 kg/m2,性别不限,ASA分级Ⅰ～Ⅲ级,NYHA心功能分级Ⅰ～Ⅲ级,采用随机数字表法,将其随机分为2组(n=30):对照组(C组)和氨甲环酸组(T组).麻醉诱导后T组经30 min静脉输注氨甲环酸1 g,然后以400 mg/h的速率持续输注至术毕；C组给予等容量生理盐水.分别于麻醉诱导前、术毕和术后24h时取中心静脉血样,测定Hb、Plt、凝血酶原时间、国际标准化比值和血浆D-二聚体、IL-6的浓度.于术后6和24h时记录胸管引流量.记录术后异体红细胞和血浆的使用情况.记录住院期间相关并发症的发生情况.结果 与C组比较,T组术毕和术后24h时D-二聚体和IL-6的浓度降低,术后胸管引流量、异体红细胞和血浆的使用率降低(P ＜0.05或0.01).两组各时点Hb、Plt、凝血酶原时间和国际标准化比值比较差异无统计学意义(P＞0.05).两组住院期间未见相关并发症的发生.结论 氨甲环酸可减轻非体外循环冠状动脉旁路移植术病人的炎性反应.

Effect of tranexamic acid on inflammatory response in pafiens undergoing off-pump coronary artery bypass grafting

Objective To investigate the effect of tranexamic acid on inflammatory response in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods Sixty ASA Ⅰ -Ⅲ and NYHA Ⅰ -Ⅲ patients of both sexes,aged 45-64 yr,with body mass index 16-22 kg/m2,undergoing elective OPCABG,were randomly divided into 2 groups ( n =30 each):control group (group C) and tranexamic acid group (group T).Anesthesia was induced with iv injection of midazolam,fentanyl and pipecuronium.The patients were tracheal intubated and mechanically ventilated.PETCO2 was maintained at 35-45 mm Hg.Tranexamic acid 1 g was infused intravenously over 30 min after induction followed by continuous infusion at 400 mg/h until the end of operation in group T.While equal volume of normal saline was given in gtoup C.Anesthesia was maintained with inhalation of isoflurane and intermittent (i)v boluses of fentanyl and pipecuroninm.Venous blood samples were taken before induction,at the end of operation and 24 h after operation for determination of Hb,platelet count,prothrombin time,international normalized ratio and plasma D-dimer and IL-6 concentrations.The volume of chest tube drainage was collected and recorded at 6 and 24 h after operation.The requirement for transfusion of allogeneic red blood cells and fresh frozen plasma was recorded.The complications during hospital stay were also recorded.Results Compared with group C,the plasma concentrations of D-dimer and IL-6 were significantly decreased at the end of operation and 24 h after operation,and the volume of chest tube drainage and the requirement for transfusion of allogeneic red blood cells and fresh frozen plasma were significantly decreased after operation in group T ( P ＜ 0.05 or 0.01).There was no significant difference in Hb,platelet count,prothrombin time and international normalized ratio between the two groups (P ＞ 0.05).No complications occurred during hospital stay in the two groups.Conclusion Tranexamic acid can reduce inflammatory response in patients undergoing OPCABG.