氨甲环酸与醋酸去氨加压素用于胃大部切除术的止血效果及安全性比较

Comparison on the Hemostatic Effect and Safety of Tranexamic Acid and Desmopressin Acetate on Subtotal Gastrectomy

目的:比较氨甲环酸与醋酸去氨加压素用于胃大部切除术的止血效果及安全性。方法:将104例拟行胃大部切除术患者随机均分为观察组和对照组。观察组患者于手术开始前30 min给予醋酸去氨加压素注射液0.3μg/kg,加入0.9%氯化钠注射液50 ml中静脉滴注,30 min内完成;对照组患者于手术开始前30 min给予氨甲环酸氯化钠注射液100 ml静脉滴注。观察两组患者出血量、输血量、手术时间,手术前后的收缩压(SBP)、舒张压(DBP)、心率(HR)、血红蛋白(HGB)、红细胞比容(HCT)、血小板计数(PLT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)及不良反应发生情况。结果:观察组患者出血量、输血量及手术时间均显著少于对照组,两组比较差异有统计学意义(P<0.05)。两组患者术前SBP、DBP、HR、HGB、HCT、PLT、PT、FIB、APTT比较,差异均无统计学意义(P>0.05);术后两组患者的SBP、DBP均显著低于同组术前,HR均显著高于同组术前,差异均有统计学意义(P<0.05),但术后两组间比较差异均无统计学意义(P>0.05);术后观察组患者APTT显著低于同组术前及对照组术后,差异均有统计学意义(P<0.05);其他指标手术前后比较,差异均无统计学意义(P>0.05)。两组患者治疗期间均未见严重不良反应发生。结论:醋酸去氨加压素较氨甲环酸能更好地降低胃大部切除术患者的术中血压,增强患者凝血功能,减少术中出血量,缩短手术时间,且安全性相似。

OBJECTIVE： To compare the hemostatic effect and safety of tranexamic acid and desmopressin acetate on subtotal gastrectomy. METHODS：A total of 104 patients with desmopressin acetate were randomly divided into observation group and control group. Observation group was given 0.3 μg/kg desmopressin acetate injection 30 min before treatment, added into 0.9% sodium chloride injection in 50 ml within 30 min by intravenous infusion. Control group was given 100 ml tranexamic acid and sodium chloride injection by intravenous infusion. Clinical data in 2 groups was observed, including bleeding, blood transfusion, operative time, and systolic blood pressure （SBP） , diastolic blood pressure （DBP） , heart rate （HR）, hemoglobin （HGB） , hematocrit （HCT）, platelet count （PLT）, prothrombin time （PT）, fibrinogen （FIB）, activated partial thromboplastin time （APTT） before and after treatment and adverse reactions （ADR）. RESULTS： The bleeding, blood transfusion and operative time in observation group were significantly less than control group, with significant difference （P〈0.05）. There were no significant differences among the SBP, DBP, HR, HGB, HCT, PLT, PT, FIB and APTT in 2 groups before treatment （P〉0.05）. After treatment, the SBP and DBP in 2 groups were significantly lower than before treatment, HR was higher than before treatment, with significant difference（P〈0.05）. But there were no significant differences between 2 groups after treatment. APTT in observation group was significantly lower than the same group before treatment and control group after treatment, with significant difference （P〈0.05） ; there were no significant differences between 2 groups on other indexes before and after treatment（P〉0.05）. There were no obvious serious adverse reactions during the treatment. CONCLUSIONS： Desmopressin acetate can better reduce blood pressure than tranexamic acid during subtotal gastrectomy, strengthen the blood coagulation function, reduce the intraoperative bleeding and shorten the operation time with similar safety.