氨甲环酸不同给药方式对心脏手术患者凝血功能及出血量的影响

Influence of Different Tranexamic Acid Administration Methods during and after Cardiac Surgery on Coagulation Function and Postoperative Blood Loss

目的观察氨甲环酸不同给药方式对体外循环(CPB)心脏手术患者凝血功能及出血量的影响。方法选择择期CPB心脏手术患者60例,随机分为氨甲环酸+生理盐水组(氨甲环酸10 mg/kg切皮前缓慢静脉推注;随后持续输注生理盐水至术后12 h,n=30)和氨甲环酸+氨甲环酸组[氨甲环酸10 mg/kg切皮前缓慢静脉推注;随后1 mg/(kg.h)持续输注氨甲环酸至术后12 h,n=30]。在麻醉诱导前、手术结束时、次日晨8:00和术后24 h 4个时间点取血测定血常规和凝血功能。记录术中肝素和鱼精蛋白用量、CPB期间最低鼻温和肛温、CPB期间最低红细胞压积,以及术后24 h出血量和异体血输血量及输液量。结果两组患者术前及术中基本情况差异均无统计学意义(P>0.05)。两组患者各观察时间点血红蛋白浓度、血小板、活化部分凝血活酶时间、国际标准化比值、纤维蛋白原组间比较差异无统计学意义(P>0.05)。术后24 h时两组患者的出血量、异体红细胞及血浆输入量、晶体及胶体输入量差异均无统计学意义(P>0.05)。结论与术中单次剂量氨甲环酸比较,单次剂量氨甲环酸治疗后围手术期持续输注氨甲环酸并不能进一步改善凝血功能、减少术后出血量,也不能进一步减少术后异体血输血量。

Objective To evaluate the influence of different tranexamic acid administration methods during and after cardiac surgery with eardiopulmonary bypass （CPB） on coagulation function and postoperative bleeding. Methods Patients undergoing elective cardiac surgery with use of CPB （ n = 60） were randomized in a double-blind fashion to one of two treatment groups： group A （n = 30）, administered with tranexamic acid 10 mg/kg （intravenous injection slowly before skin incision） , followed by infusion of normal saline until postop- erative 12 hours; and group B （n =30）, administered with tranexamie acid 10 mg/kg （intravenous injection slowly before skin incision）, followed by infusion of tranexamic acid 1 mg/（ kg ~ h） until postoperative 12 hours. Hemoglobin, platelet count, and coagulation function were assessed before anesthesia induction, after surgery, 8am next day and 24 hours after surgery. Bleeding, allogeneic blood transfusion, and fluid infusion during the postoperative 24 hours were recorded. Result No differences were found between groups in terms of coagulant function, postoperative bleeding, allogeneic blood transfusion, and fluid infusion （P 〉 0. 05 ）. Conclusion Compared with intraoperative administration alone, prolonged treatment with tranexamic acid after cardiac surgery shows no advantage because it can not further improve coagulant function, reduce bleeding, orreduce allogeneic blood transfusion.