氨甲环酸对剖宫产术中术后出血及血液黏滞度的影响

Effect of tranexamic acid on intraoperative and postoperative bleeding of cesarean section and blood viscosity

目的评估术前静脉输注氨甲环酸对减少剖宫产术中术后失血的效果及对血液黏滞度的影响。方法选择本院拟行剖宫产的足月妊娠初产妇100例,随机分为A组(n=50)和B组(n=50),在产妇进入手术室后,开始分别输入10 mg/kg的氨甲环酸或等剂量生理盐水,输液的时间超过10 min。输液完毕20 min后,实施相同标准的麻醉与手术。观察初产妇术中术后的基本情况以及血液学指标,包括术后24 h复查产妇的血液常规、凝血时间及围手术期催产素的使用总量,测定术后72 h内不同时间点的血液黏度。结果 A组在术中出血量、术后出血量、血色素下降以及催产素的使用总量上均明显低于B组(P<0.05);两组的血液流变学指标在相同时点比较,差异无统计学意义(P>0.05)。结论剖宫产术前20 min给予10 mg/kg的氨甲环酸,可显著降低术中和术后早期失血量,并且不会带来血液黏滞度的升高。

Objective To evaluate the effect of preoperative intravenous infusion of tranexamic acid on intraoperative and postoperative bleeding of cesarean section and blood viscosity. Methods Total 100 full-term pregnant women receiving cesarean section in our hospital were selected and divided randomly into group A（n=50）and group B（n=50）. After they entered the operation room,10 mg/kg tranexamic acid or saline infusion of equivalent dose were infused,respectively,and the infusion time was more than 10 minutes. After 20 minutes since the infusion was completed,anesthesia and operation were implemented according to the same method. And then,the basic conditions of the intraoperative and postoperative hematological indexes of the women were observed,including reexamination of the routine blood indexes,blood coagulation time,and the total amount of oxytocin during the perioperative period within 24 h after the operation and the blood viscosity at different time within 72 h after the operation. Results In group A,the intraoperative and postoperative bleeding amount,the decrease of hemoglobin,and total amount of oxytocin were significantly lower than those in group B（P〈0.05）;the comparison of blood rheological indexes between two groups at the same time had no significant difference（P〉0. 05）. Conclusion Infusion of 10 mg/kg tranexamic acid 20 minutes before cesarean section can significantly reduce intraoperative hemorrhage and early postoperative hemorrhage,and will not cause increased blood viscosity.