氨甲环酸在婴幼儿心肺转流过程中的应用

The effects of tranexamic acid in pediatric extracorporeal circulation

目的采用随机对照的实验方法,在心肺转流(CPB)过程中应用高、低两种剂量的氨甲环酸,研究其对婴幼儿先天性心脏病(简称先心病)术中、术后出血量、用血量以及凝血系统功能的影响,探讨婴幼儿ECC过程中的合理用药剂量及用药方法。方法随机选取紫绀型先天性心脏病患儿45例,按照氨甲环酸用药量分为低剂量组(A组,15例),高剂量组(B组,15例)和对照组(C组,15例,未用药);于相应时间点取血,监测凝血功能、血小板数目、肝肾功能,并记录患儿术后失血量、用血量等相关指标。结果 A组与B组和C组两组比较,关胸时间明显缩短、血浆纤维蛋白原含量明显减少、血小板破坏明显减少、术后失血及用血量减少;B组与C组比较,各项指标基本无明显差异。结论在婴幼儿心肺转流过程中应用氨甲环酸,可缩短关胸时间,减少血小板破坏,且以低剂量组作用更明显。

OBJECTIVE In this random control experiment,two dosages of tranexamic acid have been used in cardiopulmonary bypass to decrease bleeding and to reduce the need for transfusion： a low dosage（10 mg/kg）,a high dosage（50 mg/kg）.We are seeking to determine whether one dosage is superior to the another.To determine a low dosage（10 mg/kg） or a high dosage（50 mg/kg） tranexamic acid used in cardiopulmonary bypass（CPB） can effectively decrease bleeding and reduce the need for transfusion in this random control experiment.METHODS 45 children with cyanotic congenital heart disease were randomly assigned to three groups（15 cases in each group）： Group A（received low dosage tranexamic acid）,Group B（received high dosage tranexamic acid） and Group C（received low dosage sodium chloride）.Blood samples were taken at three time-spots for coagulation studies,platelet count,liver and kidney function test.Also the amount of postoperative cumulative blood loss and transfusion of blood products were recorded.RESULTS Comparing with those in Group B and C,patients in Group A has the shortest sternal closure time,the least amount of fibrinogen,the most amount of platelet and less blood loss.But there is no significant difference between Group B and C.CONCLUSION The use of low dosage tranexamic acid in pediatric CPB is superior to short the sternal closure time and raise the amount of platelet.