氨甲环酸与半量抑肽酶在小儿先天性心脏病手术中的疗效与安全性比较

目的:评估氨甲环酸和半量抑肽酶在儿科先心手术中应用的安全性和有效性。方法:90例先心患儿随机分为3组,手术中分别接受半量抑肽酶(抑肽酶组30例)、氨甲环酸(氨甲环酸组30例)或等量生理盐水(对照组30例)。抗纤溶药物有效性评价指标包括:术后24 h胸腔引流量、输血例数比例、血制品用量;安全性评价指标包括:术后肾功能不全发生率、神经系统并发症发生率和住院病死率。结果:半量抑肽酶组及氨甲环酸组术后出血量较对照组明显减少,差异有统计学意义(P<0.05),2种药物止血效果差异无统计学意义(P>0.05)。半量抑肽酶组和氨甲环酸组间在输血例数比例、输血量、术后气管拔管时间、肾功能障碍、神经系统并发症、ICU滞留时间及住院病死率方面差异均无统计学意义(P>0.05)。结论:在儿科先心手术中应用半量抑肽酶和氨甲环酸是安全的,二者有相近的抗纤溶作用,均能明显减少术后出血、抑制纤溶亢进。

Comparison of curative effect and safety between hexametric acid and half dose aprotinin for pediatric congenital heart disease surgery

Objective:To evaluate the safety and efficacy of hexametric acid and half dose aprotinin for pediatric congenital heart disease(CHD) surgery.Methods:A total of 90 patients with CHD were randomly divided into three groups,30 patients in each group,then the patients in the three groups were treated with half dose aprotinin(half dose aprotinin group),hexametric acid(hexametric acid group),and normal saline of the same volume(control group),respectively.The evaluation indexes of effectiveness of antifibrinolytic agent included the amount of postoperative 24-hour chest drainage,the proportion of patients receiving blood transfusion,and the dose of blood products;the evaluation indexes of safety included the incidence of postoperative renal insufficiency,the incidences of complications of nervous system,and the case fatality rate in hospital.Results:The amounts of blood loss after operation in half dose aprotinin group and hexametric acid group were significantly lower than that in control group(P<0.05).There was no statistically significant difference in the effect of hemostasis between half dose aprotinin group and hexametric acid group(P>0.05).There was no statistically significant difference in the proportion of patients receiving blood transfusion,the amount of blood transfusion,postoperative removing time of tracheal intubation,the incidences of renal dysfunction and complications of nervous system,the residence time in ICU,and the case fatality rate in hospital between half dose aprotinin group and hexametric acid group(P>0.05).Conclusion:Half dose aprotinin and hexametric acid are safe for pediatric CHD surgery,they have similar antifibrinolytic agents,and they both can reduce postoperative bleeding and inhibit hyperfibrinolysis.