氨甲环酸对心内直视术患者的血液保护效果

目的探讨氨甲环酸(TAX)对心内直视术患者的血液保护效果。方法择期行房间隔缺损修补术和(或)室间隔缺损修补术的先天性心脏病患者60例,随机分为TAX组(T组)和对照组(C组)。T组在麻醉诱导后给予TAX10mg/kg,停机时追加TAX10mg/kg,手术结束时再补充TAX10mg/kg;C组给予等量生理盐水。于麻醉诱导前、CPB30min、鱼精蛋白中和肝素后10min、术后6h、12h和24h分别测定PT、APTT、纤维蛋白原FIB、FDP、D-D;记录术后12h、24h每公斤体重纵膈心包引流量和成分输血量。结果两组患者PT及APTT在围手术期变化基本一致。与C组比较,T组FIB、FDP和D-D浓度在麻醉诱导前差异无统计学意义(P>0.05),在T1~T3时FIB浓度升高(P<0.05),FDP和D-D浓度降低(P<0.05),在T4和T5时FIB、FDP和D-D浓度差异无统计学意义(P>0.05)。T组术后12h、24h每公斤体重纵膈心包引流量及术后成分输血量明显少于C组,差异有统计学意义(P<0.05)。结论氨甲环酸可明显减少心内直视术患者术后失血量与输血量,其机制与抑制纤溶系统过度激活有关。

Blood conservation effects of tranexamic acid in patients undergoing open heart surgery

Objective To evaluate the blood conservation effects of tranexamic acid (TAX) in patients undergoing open heart surgery. Methods Sixty patients undergoing repair of atrial septal defect and (or) ventricular septal defect, were randomly divided into two groups (n=30): TAX group (group T) and control group (group C). In group T, TAX (10 mg/kg) was injected after induction of anesthetic, stopping CPB and finishing surgery. Group C was given equal volumes of saline solution. The plasma concentrations of prothrombin time (PT), activated partial thromboplastin time (APTT), Fibrinogen (FIB), fibrin degradation product (FDP) and D-dimer (D-D) were measured before induction of anesthetic (baseline,T0), at 30 min during CPB (T1), 10 min after protamine injection (T2), and at 6 h (T3), 12 h (T4) and 24 h (T5) after surgery. The total drainage and transfusion of blood products were measured at 12 h and 24 h after surgery. Results PT and APTT were in the similar changes for the two groups in preoperative period. There were no significant differences of FIB, FDP and D-D between the two groups before induction of anesthetic. The plasma concentrations of FIB was significantly higher (P<0.05), FDP and D-D were significantly lower at T1~T3 in group T than in group C (P<0.05). There were no significant differences of FIB, FDP and D-D between the two groups at T4 and T5 after surgery. The total drainage and transfusion of blood products were significantly lower in group T than in group C (P<0.05). Conclusion TAX can reduce postoperative bleeding and blood transfusions in patients underwent open heart surgery, whose mechanism is related to inhibiting excessive activation of fibrinolytic system.