体外循环围术期栓溶二聚体动态变化及抗纤溶药疗效的观察

Changes of Plasma D-dimer and Efficacy of Antifibrinolytic Agents in Patients Undergoing Cardiopulmonary Bypass

目的：观察体外循环（ＣＰＢ）围术期栓溶二聚体动态变化及抗纤溶药的疗效。方法：３０例成人心脏手术患者分为３组。①抑肽酶组：ＣＰＢ中给抑肽酶２×１０６ｋＩＵ；②氨甲苯酸组：于ＣＰＢ前、中、后各给氨甲苯酸２５０ｍｇ；③对照组。于麻醉诱导后、给肝素１０分、ＣＰＢ５分、ＣＰＢ３０分、ＣＰＢ结束时、给鱼精蛋白后１０分及手术结束时测定血浆栓溶二聚体含量。结果：与对照组相比，抑肽酶组ＣＰＢ中栓溶二聚体值略降低，术后２４小时胸液量减少２９．２％（Ｐ＜０．０５），氨甲苯酸组给鱼精蛋白后１０分栓溶二聚体值明显降低（Ｐ＜０．０５），胸液量减少３２．８％（Ｐ＜０．０５）。结论：抑肽酶在ＣＰＢ初期。

? Objective:To observe the changes of plasma D-dimer concentration and efficacy of antifibrinolytic agents in patients undergoing cardiopulmonary bypass(CPB) Methods:Thirty patients were divided into three groups:Group A,11 Patients received 2×106kIU aprotinin in pump prime;group B,8 patients received 250 mg paminomethyl benzoic acid(PAMBA) before,during and after CPB,respectively;group C,11 controlsDdimer were determined after the induction of anaesthesia,10 minutes after heparinization,at the 5,30 minutes and the end of CPB,10 minutes after injection of protamine and at the end of operation,respectively Results:As compared with the control group,there were slightly decrease in Ddimer(p<005) during CPB and significant decrease in chest tube drainage (p<005) at the first 24hour after operation in the aprotinin group;a significant decrease in Ddimer (p<005) after injection of protamine and 32.8% reduction in 24hour postoperative drainage in the PAMBA group Conclusion:Our results indicate that both aprotinin and PAMBA posseses antifibrinolytic effect on patients undergoing CPBThe former acts mainly at the early time of CPB,while the latter at both periCPB and postCPB periods