氨甲环酸对发绀型先天性心脏病患儿的血液保护效果

Blood Conservative Effects of Tranexamic Acid on Children with Cyanotic Congenital Heart Disease

目的探讨氨甲环酸(TAX)在体外循环(CPB)中对发绀型先天性心脏病(先心病)患儿的血液保护效果。方法选择经皮血氧饱和度[Sp(O2)]<80%的2～12岁的发绀型先心病患儿60例,随机分为TAX组和对照组,每组30例。TAX组在麻醉诱导后给予TAX 10 mg.kg-1,CPB预充液中加入10 mg.kg-1 TAX,鱼精蛋白中和肝素后再追加10 mg.kg-1 TAX。对照组给予等量9 g.L-1盐水。于麻醉诱导前(基础状态,T1)、鱼精蛋白中和肝素后10 min(T2)、术后12 h(T3)、术后24 h(T4)分别测定血浆凝血酶原时间(PT)、活化部分凝血激酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)、血小板计数和血小板聚集功能;记录术后12 h、24 h每公斤体质量纵隔心包引流量和成分输血量。结果 TAX组各指标在麻醉诱导前与对照组比较无统计学差异(Pa>0.05)。在T2、T3时,TAX组与对照组比较PT、APTT无统计学差异(P>0.05),FIB明显升高(P<0.01),D-D明显降低(P<0.01),血小板计数和聚集功能明显升高(P<0.01)。在T4时TAX组PT、APTT、FIB和D-D与对照组比较均无统计学差异(Pa>0.05),血小板计数和聚集功能均明显升高(Pa<0.01)。TAX组T3、T4时累计心包纵隔引流量及术后成分输血量与对照组比较明显下降,差异均有统计学意义(Pa<0.01)。结论 TAX对发绀型先心病患儿抗纤溶作用和血小板保护作用明显,并可减少术后失血量与输血量。

Objective To study the blood conservative effects of tranexamic acid（TAX） on children with cyanotic congenital heart di-sease under cardiopulmonary bypass（CPB）. Methods Sixty children aged 2-12 years old with cyanotic congenital heart disease and low saturation of blood oxygen（80%） were randomly divided into 2 groups（n=30,each）：control group and TAX group.In TAX group,patients were given TAX in a dose of 10 mg·kg^-1 after induction of anesthesia,a dose of 10 mg·kg^-1 in the pump prime,and a dose of 10 mg·kg^-1 after protamine injection respectively.In control group,patients acted as control and received normal saline.The plasma concentrations of prothrombin time（PT）,activated partial thromboplastin time（APTT）,fibrinogen（FIB）,D-dimer（D-D）,the platelet count and aggregation were measured respectively before induction of anesthesia（baseline,T1）,at 10 min after protamine injection（T2）,at 12 h after surgery（T3）,and at 24 h after surgery（T4）.The total drainage and transfusion of blood products were measured at T3 and T4. Results There were no significant differences in all outcomes among the two groups before induction of anesthesia（P〈0.05）.The plasma concentration of FIB was significantly higher while the D-D was significantly lower（P〈0.01）,and the platelet count and aggregation were significantly higher（P〈0.01） at T2 and T3 in TAX group than those in control group.There were no significant differences in PT,APTT,FIB and D-D between the two groups at T4（P〈0.05）,the platelet count and aggregation were significantly higher（P〈0.01） at T4 in TAX group than those in control group.The total drainage and transfusion of blood products were significantly lower in TAX group than those in control group（P〈0.01）. Conclusions TAX is effective in inhibiting fibrinolysis and protecting platelet function as well as reducing postoperative bleeding and blood transfusions in children with cyanotic congenital heart disease under cardiopulmonary bypass.