止血芳酸应用于体外循环心脏手术的临床观察

The Application of P-Aminomthy Benzonic Acid to Patients Operated on with Cardiopulmonary Bypass

目的 :研究止血芳酸 (PAMBA)对体外循环 (CPB)心脏手术中凝血功能的影响 ,以评估其临床应用价值。方法 6 0例择期CPB心脏手术病人 ,随机分为两组 (每组 30例 ) ,观察组 (A组 )于CPB转流前、CPB预充液中以及鱼精蛋白中和后 10min ,经中心静脉分别给予PAMBA 2 5 0mg ;对照组 (B组 )不给药。分别在麻醉诱导后切皮前、CPB后 30min、CPB停机及手术结束时四个时点检测血小板计数 (BPC)、激活全血凝固时间 (ACT)、白陶土部分凝血活酶时间(KPTT)、凝血酶原时间 (PT)和凝血酶时间 (TT) ,并同时观察术前、术后 2 4h的血红蛋白 (Hb)、红细胞压积 (Hct)以及术后的出血量和输血量。结果转流后两组血小板计数均明显减少 ;观察组和对照组相比血小板计数降低程度明显减轻 (P <0 .0 5 ) ;两组间各时点的ACT、KPTT、PT、TT相比较均无显著性差异 ,而观察组的Hb、Hct降低和出血量及输血量明显少于对照组 (P <0 .0 5 )。结论CPB期间应用PAMBA不仅能抑制纤溶系统亢进并间接保护血小板功能 ,从而有效地减少CPB心脏手术后非外科性出血 。

Objective: To investigate the effect of PAMBA on blood coagulation during cardiac surgery with CPB and evaluate its clinical value. Methods: 60 patients undergoing selective cardiac surgery with CPB were divided randomly into two groups. In observation group (group A, n =30), PAMBA 250mg in CPB priming fluid was administered pre-bypass and at 10min after protamine neutralization, whereas in control group (group B, n =30) the medicine was not. The central venous blood samples were taken to measure the blood platelet count (BPC), activated clotting time (ACT), kaolin partial thromboplastin time (KPTT), prothrombin time (PT), and thrombin time (TT) as soon as anesthetic induction,at 30 min after CPB, after weaning from CPB, and at the end of operation, respectively. Meanwhile hemoglobin (Hb), hematocrit (Hct), and the postoperative volumes of bleed and blood transfusion were also observed. Results: BPC decreased obviously in both group A and B during and after CPB. BPC in group B was lower than that in group A( P <0.05).There were not significant differences of ACT, KPTT, PT, and TT between two groups. However, there were less decreases of Hb and Hct, and the volumes of bleed and blood transfusion were significantly less ingroup A than those in group B( P <0.05).Conclusion:The intravenous PAMBA may reduce the postoperative nonsurgical bleeding of patients undergoing cardiac surgery with CPB, but not influence on the monitoring of blood coagulation.