6-氨基己酸对儿童先心病体外循环时纤溶系统的影响

Effect of Aminocaproic Acid on Fibrinolysis System During the Extracorporeal Circulation Period of Children's Congenital Heart Disease

目的观察6-氨基己酸(EACA)对儿童体外循环(CPB)时纤溶系统及围术期出血量的影响。方法 40例先心病患儿随机均分为用药组(EACA组)和对照组(C组)。分别于切皮前即刻(T0)、CPB30min(T1)、鱼精蛋白中和肝素后10min(T2)、术后2h(T3)和术后24h(T4)时采集静脉血,测定血浆组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制剂(PAI)、纤溶酶(Plm)活性及D-二聚体(D-di-mer)浓度,同时记录术后24h内出血量。结果与T0比较,C组血浆t-PA、t-PA/PAI活性在T1-3、Plm活性在T2-3、D-dimer浓度在Tl-4时升高(P<0.05或0.01)。与C组比较EACA组血浆t-PA活性、t-PA/PAI在T1-3、Plm活性在T1-4、D-dimer浓度在T1-4时降低(P<0.05或0.01)。术后24h出血量EACA组少于C组(P<0.05)。结论 EACA可有效地抑制儿童CPB期间纤溶系统的激活,明显减少术后失血量。

Objective To observe the effect of aminocaproic acid on fibrinolysis system and postoperative bleeding of children undergoing extracorporeal circulation. Methods Forty childran with congenital heart disease were randomly divided equally into 2 groups; group （ EACA ） and group C（ contro1） Blood samples were taken from patients in the study groups at the following time points：before the onset of operation（ T0） ,at 30 min after CPB onset（ T1） ,10 min after protamine administration（ T2） ,at 2 h after operation（ T3） and 24 h after operation（ T4）. Measured parameters included tissue-type plasminogen actlvator（ t-PA） ,plasminogen activatorinhibitor（ PAI） ,plasmin（ Plm） activity and D-dimer（ D-D）. The amotmt of blood drained from chest within 24 h after operation were recorded. Results （ 1） Group C（ control group） ：PAI activity was maintained stable pefioperatively. The t-PA activity and t-PA/PAI ratio increased significantly during operation but returned to the baseline value 2 h after operation. D-dimer level also significantly increased during and after operation. The Plm activity increased significantly after the onset of CPBand 10 min after protamine administration comparedtothe baseline value. （ 2） The t-PA activity and t-PA/PAI ratio were significantly lower in group EACA than in group C. The D-dimer level and Plm activity were also significantly lower in group EACA than in group C during and after operation. The amount of blood loss within 24 h after operation in group EACA was less than that in group C. Conclusion EACA can inhibit the activation of the fibrinolysis system during CPB in children patients,and reduce the postoperative bleeding remarkably.