氨甲环酸在开胸手术中的应用

Using tranexamic acid in patients undergoing thoracotomy.

目的评价氨甲环酸在开胸手术中的止血作用和对开胸手术围术期凝血纤溶功能的影响。方法选择因罹患肺或食管肿瘤的开胸手术患者40例,随机分为两组:氨甲环酸组(A组,n=20)在麻醉诱导后切皮前静脉滴注10mg/kg氨甲环酸,术中持续泵注1mg.kg-1.h-1至术毕;对照组(B组,n=20)持续泵注生理盐水。分别于术前,术中3h,术后第1天和第3天抽取中心静脉血检测血栓弹力图(TEG),凝血常规,包括凝血酶原时间(PT),部分活化凝血酶时间(APTT)和纤维蛋白原(Fib)含量,及血浆D-二聚体含量,并记录术中出血量和术后24h胸腔引流量。结果T组术中、术后CI均明显高于对照组,术后LY30显著低于对照组(P<0.05);T组术中和术后D-二聚体含量均明显低于C组(P<0.01);T组术中出血量和术后24h胸腔引流量明显少于C组(P<0.01)。结论氨甲环酸抑制了纤溶活性的增强,改善了开胸手术后早期的低凝状态,显著减少了开胸手术围术期的血液丢失。

Objective To evaluate the effects of tranexamic acid on coagulation and fibrinolysis in patients undergoing thoracotomy.Methods Forty ASA Ⅰ-Ⅱ patients with lung cancer or esophageal carcinoma undergoing thoracic surgery were nmdomly divided into two groups： Groop T receiving 10mg/kg tranexamic acid as a bolus before skin inciscion and mg·kg^-1·h^-1 during surgery, Group C receiving isotonic saline infusion instead（ n = 20 in each group） .The venous blood samples were taken from all the patients before operation,at 3 hours after the beginning of oparation, on the 1st and 3rd days after operation, respectively.Thromboelastography（TEG） ,prothrombin time（PT）, actived partial thromboplastin time（ APTF）, fibriongm（Fib） concentration and D-Dimer concentration were monitored.The volume of introperative blood loss and chest tube drainge at 24 hours postenpemtively were recorded. Results CI were significandy higher in Group T than in Group C during and after operation,and LY30 was significantly lower in Group T than in Group C after operation（ P 〈 0.05） .Intro-and post-operative D-Dimer concentrations in Group T were signifucantly lower than those in Group C（ P 〈 0.01 ） .The volume of intraoperetive blood loss and chest tube drainage at 24 hours postoperstively in Group T was significantly lower than that in Group C（ P 〈 0.01 ）. Conclusion Tranexamic acid inhibit the increase of fibrinolysis,and alleviate the hypocoagulatable state in early period after thoracotomy, and tranexamic acid can reduce the perioperafive blood loss in patients undergoing thoreentomy.