注射用血凝酶复合氨甲环酸对非体外循环冠状动脉旁路移植术患者的血液保护作用

Blood-saving effect of combination of hemocoagulase artox for injection and tranexamic acid in patients an- dergoing off-pump coronary artery bypass grafting

目的评价注射用血凝酶复合氨甲环酸用于非体外循环冠状动脉旁路移植术（OP．CABG）患者的血液保护作用。方法择期拟行OPCABG患者80例，年龄50-70岁，性别不限，体重50。100kg，ASA分级Ⅱ级，心功能NYHA分级I或Ⅱ级。采用随机数字表法，将患者随机分为4组（n=20）：对照组（C组）、注射用血凝酶组（H组）、氨甲环酸组（T组）和注射用血凝酶复合氨甲环酸组（HT组）。H组切皮前20min静脉滴注注射用血凝酶O．04U／kg（最高剂量4u），静脉注射鱼精蛋白后15min时追加2U，然后每隔2h追加2U至术毕；T组切皮时静脉滴注氨甲环酸20mg／kg，以10mg·kg-1·h-1的速率输注至术毕；HT组按上述两组的给药方法复合用药。记录术中出血量，异体红细胞和血浆使用情况，术后0～6和6～24h引流量，总引流量和输血量。记录术后深静脉血栓形成的发生情况。结果与C组比较，T组和HT组术中出血等级降低，T组、H组和HT组异体红细胞输入量、血浆输入量，术后0．6、6～24h引流量和总引流量降低（P〈0．05）；与H组和T组比较，HT组异体红细胞输入量、血浆输入量，术后0—6、6—24h引流量和总引流量均降低（P〈0．05）。四组均未见深静脉血栓形成的发生。结论注射用血凝酶复合氨甲环酸用于OPCABG患者的血液保护作用优于单独应用，且不增加血栓形成的风险。

Objective To evaluate the blood-saving effect of combination of hemocoagulase artox for in- jection and tranexamic acid （TXA） in patients undergoing off-pump coronary artery bypass grafting （OPCABG）. Methods Eighty ASA Ⅱ patients （NYHA Ⅰ or Ⅱ ）, aged 50-70 yr, weighing 50-100 kg, scheduled for elective OPCABG, were randomly divided into 4 groups （ n = 20 each） ： control group （group C）, hemocoagulase atrox for injection group （group H, n = 20）, TXA group （group T） and hemocoagulase atrox for injection ＋ TXA group （group HT）. Hemocoagulase atrox 0.04 U/kg （the highest dose 4 U） was injected at 20 min before skin incision, and additional hemocoagulase atrox 2 U was given every 2 h starting from 15 min after administration of protamine until the end of operation in group H. TXA 20 mg/kg was injected intravenously at skin incision, followed by a continuous infusion of TXA at 10 mg kg-1 . h-1 until the end of operation in group T. Hemocoagulase atrox and TXA were given as the method described in groups H and T. Venous blood samples were taken from the central vein before operation, at the end of operation, and 24 h after operation to determine the plasma D-Dimer concen- tration. The amount of blood loss, allogeneic red blood cells and plasma infused during operation, volume of drain- age during 0-6 and 6-24 h after operation, total volume of drainage and volume of allogeneic blood transfused dur- ing operation were recorded. The deep vein thrombosis was recorded. Results Compared with group C, the amount of blood loss during operation was significantly decreased in groups T and HT, and the allogeneic red blood cells and plasma infused during operation, and volume of drainage during 0-6 and 6-24 h after operation, and total volume of drainage were significantly decreased in groups H, T and HT （ P 〈 0.05）. Compared with groups H and T, the allogeneic red blood ceils and plasma infused during operation, and volume of drainage during 0-6 and 6-24 h after operation, and total volume of drainage were significantly decreased in group HT （ P 〈 0.05 ）. No deep vein thrombosis was observed in the 4 groups. Conclusion The combination of hemocoagulase artox for injection and TXA provides better blood-saving effect than either alone for the patients undergoing OPCABG without increas- ing the risk for thrombosis.