氨甲环酸对心肺转流病人纤溶系统的影响

Effects of tranxamic acid on fibrinolysis in cardiac patients under cardiopulmonary bypass

目的 比较氨甲环酸 (血速宁 )与抑肽酶对心肺转流 (CPB)术中纤溶系统、血小板及术后出血量的作用 ;探讨两种给药方法的效果。方法 80例行心脏直视术患者随机分为抑肽酶 (A)组、氨甲环酸 1(TA 1)组和氨甲环酸 2 (TA 2 )组。A组将抑肽酶 30 0万KIU于CPB前一次加入预冲液中 ;TA 1组诱导后即静注负荷量氨甲环酸 2 0mg/kg ,然后以 2mg·kg-1·h-1持续静注达 10小时 ;TA 2组诱导后先静注负荷量氨甲环酸 2 0mg/kg ,停CPB时追加 2 0mg/kg ,术毕再补充 10mg/kg。分别于诱导后、CPB 30分钟、停CPB鱼精蛋白中和后 10分钟及CPB后 2小时测定血小板计数、血栓素B2 (TXB2 )、血小板α膜蛋白 14 0 (GMP 14 0 )、纤溶酶活性 (Plm)、纤维蛋白降解产物 (FDP)。并记录术后 12小时、2 4小时胸液引流量和出血量。结果 氨甲环酸组与抑肽酶组相比 ,在血小板计数、纤溶酶活性、FDP浓度及术后引流量及输血量均无显著差别 (P >0 0 5 )。氨甲环酸组CPB开始后TXB2浓度高于抑肽酶组 (P <0 0 1) ,且CPB后GMP 14 0浓度恢复较抑肽酶组缓慢 (P <0 0 5 )。两种不同给药方式在术中出血量、术后引流量方面也无显著性差异。结论 小剂量持续给药和负荷 追加 补充给药法应用氨甲环酸在抑制纤溶。

Objective To compare the efficacy of tranexamic acid with aproitin on fibrinolysis,platelet count and postoperative bleeding in cardiac patients operated under cardiopulmonary bypass(CPB).Methods Eighty patients scheduled for cardiac surgery were randomly divided into three groups:aprotinin(group A),tranexamic acid 1(group TA 1),tranexamic acid 2(group TA 2).In group A aprotinin(3×10 6KIU)was added to CPB priming solution.In group TA 1 medication was received by way of loading does(20mg/kg before induction)followed by continuous injection(2mg·kg -1 ·h -1 ).In group TA 2,tranexamic acid(20mg/kg) was injected before induction,then supplemented when stopping CPB and finishing surgery according to 20mg/kg and 10mg/kg respectively.The platelet count, TXB 2,GMP 140,Plm,FDP,volume of blood loss and postoperative chest tube drainage were measured after induction,at 30min during CPB,10min after protamine injection and 2h after CPB.Result There were no significant differences in the magnitude of platelet, Plm,FDP,chest tube loss and postoperative transfusion between group A and group TA compared with group A the concentrations of TXB 2 were higher in group TA,and the concentrations of GMP 140 reduced more slowly after CPB.There were no significant differences in all outcomes between group TA 1 and group TA 2.Conclusions Two kinds of tranexamic acid medications were effective as aprotinin treatment in antifibrinolysis and reducing bleeding.But aprotinin therapy was more effective than tranexamic acid treatment in protecting blood platelet. [