婴幼儿体外循环期间氨甲环酸血液浓度研究

Study of plasma concentration of tranexamic acid during cardiopulmonary bypass in infants with tetralogy of Fallot

目的研究婴幼儿法洛四联症(tetralogy of fallot,TOF)根治术体外循环(cardiopulmonary bypaass,CPB)期间应用氨甲环酸(tranexamic acid,TA)的血液浓度。方法 5例先天性TOF患儿,体质量(7.36±2.08)kg,在开胸前应用TA100 mg/kg,单次静脉缓慢注射(>10 min),CPB开始前再次注射100 mg/kg。应用磁共振波谱仪(1H-NMR)方法,检测不同时间段TA的血液浓度。结果 CPB开始前(负荷剂量用药后约20 min)、CPB开始后1 h、手术结束时的血液TA浓度分别为(224.61±195.28)、(509.58±181.57)、(243.95±32.30)μg/mL。CPB开始前与CPB开始后1 h及手术结束时TA浓度比较均无统计学差异(P=0.052、0.83);CPB开始后1 h与手术结束时TA浓度有统计学差异(P=0.02)。结论1H-NMR能够检测出TA的血液浓度。TA大于抑制有高度出血风险可能需要的血液浓度125μg/mL时,提示可降低剂量。

Objective To study the plasma concentration of tranexamic acid（TA） during cardiopulmonary bypass in infants with tetralogy of Fallot（TOF）.Methods Five TOF infants with body weight of（7.36±2.08） kg were given an slow intravenous injection of initial dose of TA（100 mg/kg,10 min） before thoracotomy,following by another 100 mg/kg TA before the initiation of cardiopulmonary bypass（CPB）.The concentration of TA was measured in blood plasma using 1H-NMR spectroscopy.Results Plasma TA concentrations were（224.61±195.28） μg/mL before CPB（at 20 min after TA administration）,（509.58±181.57） μg/mL at 60 min after CPB initiation,and（243.95±32.30） μg/mL at the end of operation,respectively.The plasma TA concentration before CPB was not significantly different from that at 60 min after CPB initiation（P=0.052） and that at the end of operation（P=0.83）,but there was significant difference between plasma TA concentration at 60 min after CPB initiation and that at the end of operation（P=0.02）.Conclusion A 100 mg/kg initial dose of TA followed by an infusion of 100 mg/kg before the initiation of CPB is sufficient enough to provide an effective plasma concentration,which is higher than 125 μg/mL for patients with high risk of bleeding,indicating the dose of TA can be decreased.