血栓弹力图评价氨甲环酸在体外循环中的血液保护效果的研究

Study on the Protective Effect of Tranexamic Acid Evaluated by Thromboelastography in Cardiopulmonary Bypass

目的通过血栓弹力图(TEG)对凝血功能的评估统计,评价氨甲环酸在瓣膜置换病人中的血液保护效果,进一步确定氨甲环酸在体外循环中的最佳用量。方法选择体外循环下瓣膜置换手术病人100例,随机分为A,B,C,D 4组。B组,C组,D组3组分别给予氨甲环酸粉剂(荷莫塞)总量20mg/kg,40mg/kg,60mg/kg(稀释到50ml加入灌注液中),分别在体外循环预充液及复温时各给予总量一半,A组在相应时间点给予50ml生理盐水,记录CPB前、中、后激活全血凝固时间(ACT);分别在转机前(T1),肝素中和后(T2),肝素中和后3h(T3),颈内静脉抽血进行TEG检查。结果 4组患者CPB前(T1),TEG检查的结果,4组间无统计学差异(P>0.05)。在中和后(T2),各值在4组病人之间无统计学差异(P>0.05),而在肝素中和后3h(T3),各值在B,C,D 3组与A组有明显差异(P<0.05),R值及K值均较A组明显减低,MA及a值均较A组明显增大。而B,C,D 3组间各数值无统计学差异(P>0.05);将CPB后凝血功能检查的结果同术前检查的结果进行了配对的对比分析,发现各组在CPB后的两个时间点的检查值都有明显改变(P<0.05),各组较术前R值、K值均明显延长,MA及α值均明显减小。结论体外循环心脏瓣膜置换手术中应用氨甲环酸有助于CPB术中凝血系统的保护,其作用对血小板、凝血因子纤维蛋白均有影响。20mg/kg,40mg/kg,60mg/kg3种氨甲环酸用量对瓣膜手术患者血液保护效果无显著差异,建议应用低剂量。

Objective To evaluate the protective effect of tranexamic acid in valve replacement patients through thromboelastog-raphy on coagulation function of statistical evaluation,and further to determine the optimal dosage of tranexamic acid in cardiopulmonary by-pass.Methods One hundred cases of valve replacement patients were randomly divided into four groups：A,B,C,D groups.Group B,group C and group D were respectively treated with ammonia tranexamic acid powder（ load Mo plug） and the dose is 20mg/kg,40mg/kg,60mg/kg （diluted to 50ml to join in the perfusion solution）,each half of the total amount was given in priming solution during rewarming of cardiopul-monary Bypass.Group A was given 50ml normal saline at the corresponding time points,recording the activated clotting time（ ACT） before, during and after CPB;before transfer（T1）,heparin and after（T2）,heparin and after 3h（T3）,TEG examination were performed in the inter-nal jugular vein.Results There was no significant difference about the results of TEG among the four groups before CPB（T1）.After neutral-ization（T2）,there was no significant difference among the 4 groups.While in heparin and 3h（T3）,compared to group A,the values of group B,C,D were significantly different,R values and K values were significantly lower than those in group A,MA and a values were significantly increased compared with A.But there were no significant difference among B,C,D three groups;The results of coagulation function tests be-fore and after CPB were compared and analysed,and the results showed that the two time points after CPB were significantly different.Com-pared to the preoperative,the value R and K were significantly prolonged,and the value MA and a were significantly decreased.Conclusion The application of tranexamic acid contribute to the protection of the coagulation system during cardiopulmonary bypas in heart valve replace-ment surgery,either to platelet or to coagulation factor fiber protein.20mg/kg,40 mg/kg,60mg/kg tree doses of tranexamic acid dosage have no significant difference on the effects of blood conservation in patients with valvular operation,suggests the application of low dose.