两种抗纤溶治疗方案对体外循环心脏手术患者围术期血浆纤维连接蛋白水平的影响

目的:评估两种抗纤溶治疗方案对体外循环心脏手术患者围术期血浆纤维连接蛋白水平和术后出血的影响。方法:将入组的139例行体外循环冠状动脉旁路移植术或瓣膜置换术患者采用计算机生成随机数字表法分为三组:低剂量组(n=46)、高剂量组(n=46)和对照组(n=47);低剂量组即氨甲环酸负荷量10 mg/kg,维持量10 mg/(kg·h);高剂量组即氨甲环酸负荷量20 mg/kg,维持量15 mg/(kg·h);对照组即给予等容量生理盐水。三组各顺序选择20例患者,分别于手术开始前(T1)、手术结束时(T2)、术后6 h(T3)和术后24 h(T4)时间点取静脉血,用酶联免疫吸附测定(ELISA)法测定血浆纤维连接蛋白的水平。记录并比较三组术后胸管引流量和异体红细胞(异体RBC)、血小板(PLT)及新鲜冰冻血浆(FFP)的使用情况。结果:低剂量组和高剂量组患者术后血浆纤维连接蛋白水平均显著高于对照组(P均<0.05)。低剂量组与高剂量组比,患者血浆纤维连接蛋白水平差异无统计学意义(P>0.05)。对照组患者血浆纤维连接蛋白水平于T3逐渐升高,低剂量组和高剂量组患者分别于T2逐渐升高,三组患者血浆纤维连接蛋白水平均于T4达到24 h内峰值,均显著高于术前水平(P均<0.05)。低剂量组和高剂量组患者术后总引流量较对照组明显减少,异体RBC、FFP、PLT使用量和使用率均显著下降(P均<0.05)。结论:氨甲环酸可以提高患者术后血浆纤维连接蛋白表达,同时减少体外循环术后出血和异体输血。

Effects of Two Anti-fibrinolytic Strategies on Perioperative Plasma Fibronectin Levels in Patients Undergoing Cardiac Surgery Under Cardiopulmonary Bypass

Objectives:To evaluate the effects of two anti-fibrinolytic strategies on postoperative plasma fibronectin(FN)levels and bleeding in patients undergoing cardiac surgery under cardiopulmonary bypass.Methods:A total of 139 patients undergoing coronary artery bypass grafting or valve replacement under cardiopulmonary bypass were randomly divided into 3 groups according to the dose of tranexamic acid:low dose group(n=46):loading dose was 10 mg/kg and maintenance dose was 10 mg/(kg·h);high dose group(n=46):loading dose was 20 mg/kg and maintenance dose was 15 mg/(kg·h);and the control group(n=47):equal volume saline was applied.The level of plasma FN was determined by enzymelinked immunosorbent assay(ELISA)before surgery(T1),at the end of surgery(T2),6 hours after surgery(T3),and 24 hours after surgery(T4).The chest tube drainage volume and the use of allogeneic red blood cells(allogeneic RBC),platelets(PLT),and fresh frozen plasma(FFP)were recorded and compared among groups.Results:The level of plasma FN was significantly higher in the low dose group and high dose group than in the control group(P<0.05).The level of plasma FN was similar between the low dose group and high dose group.The level of plasma FN began to increase at T3 in the control group,began to increase at T2 in the low dose group and high dose group,all peaked at T4 and was significantly higher at T4 than the baseline level(all P<0.05).Compared with the control group,the postoperative chest drainage volume and the consumption of blood products(allogeneic RBC,FFP,PLT)were significantly lower in the low dose group and the high dose group than in the control group(all P<0.05).Conclusions:Tranexamic acid can promote secretion of plasma fibronectin,while reduce postoperative bleeding and allogeneic transfusion in patients undergoing cardiac surgery under cardiopulmonary bypass.