氨甲环酸对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 tranexamic acid in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass

目的评价氨甲环酸对体外循环冠状动脉旁路移植术患者的血液保护作用。方法本研究为前瞻性、随机、双盲、对照、临床研究，择期行体外循环冠状动脉旁路移植术患者200例，年龄18～64岁，体重50～100kg，ASA分级Ⅰ～Ⅳ级。采用随机双盲法，将患者随机分为2组（n=100）：对照组（C组）和氨甲环酸组（T组）。麻醉诱导后T组静脉输注氨甲环酸负荷量10mg／kg（输注时间20min），然后以10mg·kg^-1·h^-1的速率静脉输注至术毕；C组给予等容量生理盐水。记录术后总引流量、术后大出血及二次开胸止血情况。记录围术期异体血使用情况、围术期并发症发生情况。结果与C组比较，T组术后总引流量、大出血发生率、二次开胸止血率降低（P〈0．05），异体浓缩红细胞、血小板和新鲜冰冻血浆输入量和使用率均降低（P〈0．05）。两组并发症发生率比较差异无统计学意义（P〈0．05）。结论氨甲环酸对体外循环冠状动脉旁路移植术患者具有血液保护作用，可显著减少术后出血与异体输血。

Objective To evaluate the blood-saving effect of tranexamic acid in patients undergoing coronary artery bypass grafting （CABG） with cardiopulmonary bypass （CPB）. Methods The study was a prospective, randomized and placebo-control trial. Two hundred ASA Ⅰ-Ⅳ patients, aged 18-64 yr, weighing 50-100 kg, were randomized to receive placebo （group C, n = 100） or tranexamic acid （group T, n = 100）. Tranexamic acid 10 mg/kg was intravenously infused over 20 min before skin incision followed by continuous infusion at 10 mg· kg^- 1. h^- 1 until the end of operation in group T. While the equal volume of normal saline was given in group C. The total volume of postoperative chest tube drainage, postoperative massive bleeding and a second thoracotomy for stopping the bleeding were reordered. The requirement for transfusion of allogeneic blood and complications during the perioperative period were also recorded. Results Compared with group C, the total volume of postoperative chest tube drainage and incidences of postoperative massive bleeding and a second thoracotomy for stopping the bleeding were significantly decreased, and the requirement for transfusion of allogeneic red blood ceils, platelet and fresh frozen plasma was reduced in group D （P 〈 0.05）. There was no significant difference in the incidence of complications between the two groups （ P 〈 0.05）. Conclusion Tranexamic acid exerts the blood-saving effect in patients undergoing CABG with CPB and can significantly reduce postoperative bleeding and transfusion of allogeneic blood.