氨甲环酸对体外循环法洛四联症矫正术患儿的血液保护效应

Blood-saving effect of tranexamic acid in pediatric patients undergoing radical correction of tetralogy of Fallot with cardiopulmonary bypass

目的评价氨甲环酸对体外循环（CPB）法洛四联症矫正术患儿的血液保护效应。方法择期行CPB法洛四联症矫正术患儿56例，性别不限，年龄11个月～14岁，BMI9．8～21．4kg／m^2，ASA分级为Ⅱ或Ⅲ级，左室射血分数〉50％，采用随机数字表法分为2组：氨甲环酸组（TA组，n=30）和生理盐水对照组（NS组，H=26）。TA组切皮前经20min静脉输注氨甲环酸负荷量10mg／kg，继以10mg·kg^-1·h^-1速率维持至术毕，NS组按照同样方法给予等容量生理盐水。记录术后24h引流量、红细胞、新鲜冰冻血浆、血小板和冷沉淀的输入量，记录二次开胸止血情况和TA组术后1周门静脉及肝动脉血栓的发生情况。结果与NS组比较，TA组术后24h引流量、红细胞、新鲜冰冻血浆、血小板及冷沉淀输入量减少（P〈0．05）。TA组无二次开胸止血，NS组二次开胸止率血15％。TA组均未见门静脉及肝动脉血栓。结论氨甲环酸（负荷量10mg／kg，维持量10mg·kg～·h^-1）对CPB法洛四联症矫正术患儿具有血液保护效应，且安全性较高。

Objective To evaluate the blood-saving effect of tranexamic acid in pediatric patients undergoing radical correction of tetralogy of Fallot with cardiopulmonary bypass （ CPB）. Methods A total of 56 children of both sexes, aged 11 months-14 yr, with body mass index of 9.8-21.4 kg/m^2, of ASA physical status Ⅱ or Ⅲ, with left ventrieular ejection fraction 〉50%, scheduled for elective radical correction of tetralogy of Fallot with CPB, were randomly divided into 2 groups using a random number table： tranexamic acid group （TA group, n = 30） and normal saline group （NS group, n = 26）. Anesthesia was induced with iv midazolam, sufentanil, veeuronium and propofol. The children were endotracheally intubated and mechanically ventilated. Anesthesia was maintained with inhalation of 1%-2% sevoflurane and infusion of propofol, sufentanil and vecuronium. After induction of anesthesia, a loading dose of tranexamic acid 10 mg/kg was intravenously infused over 20 min before skin incision, followed by infusion at a rate of 10 mg·kg^-1·h^-1until the end of surgery in TA group, while the equal volume of normal saline was given instead in NS group. The volume of chest tube drainage at 24 h after surgery and volume of allogeneic red blood cells, fresh frozen plasma, platelet and cryoprecipitate transfused were recorded. The requirement for re-thoracotomy for bleeding, and the incidence of hepatic artery and portal vein thrombosis were also recorded. Results Compared to NS group, the volume of chest tube drainage at 24 h after surgery and volume of allogeneic red blood cells, fresh frozen plasma, platelet and cryoprecipitate transfused were significantly reduced in TA group. No re-thoracotomy was required in TA group, and the rate of re-thoracotomy was 15% in NS group. No hepatic artery and portal vein thrombosis were detected in group TA. Conclusion Tranexamic acid （loading dose 10 mg/kg, maintenance dose 10mg·kg^-1·h^-1） can provide blood-saving effect and has high security in pediatric patients undergoing radical correction of tetralogy of Fallot with CPB.