氨甲环酸在心内直视瓣膜置换手术中的应用

Tranexamic Acid Application in Open Heart Valve Replacement Surgery

目的研究在心内直视瓣膜置换手术中应用氨甲环酸的效果。方法选择2013年6月至2015年6月在我院收治的106例心内直视瓣膜置换患者进行手术治疗,将患者随机分为治疗组和对照组,每组各53例。对照组患者按常规方法进行手术治疗;治疗组在手术期加用氨甲环酸。观察记录两组患者术中新鲜冰冻血浆(fresh frozen plasma,FFB)用量,心脏停跳时间,手术时间,术后住院时间,术后总引流量、术后24 h红细胞悬液使用量,术后FFB用量,以及术前、术中、术后的血红蛋白(hemoglobin,Hb)浓度,血小板(platelet,Pt)浓度,激活全血凝固时间(activated coagulation time),凝血酶原时间(prothrombintime,PT),活化部分凝血活酶时间(activated partial thromboplastin time,APTT)及纤维蛋白原(fibrinogen,FIB)。结果治疗组术中FFB用量明显少于对照组(P<0.05),而手术时间、CPB时间比较无明显差异。治疗组患者术后24 h红细胞悬液输入量、术后FFB用量、术后住院时间和术后引流总量均明显少于对照组(P<0.05)。组间同时点比较,治疗组的术中术后PT、APTT明显短于对照组(P<0.05),Pt、FIB明显多于对照组(P<0.05)。结论在体外循环心内直视瓣膜置换手术中应用氨甲环酸能够对血液起到良好的保护作用,减少术中、术后输血量,有助于患者的早日康复,值得在临床中推广应用。

Objective To study the effect of tranexamic acid application in open heart valve replacement surgery. Methods From June 2013 to June 2015,there were 106 cases with open heart valve replacement were randomly divided into the observation group and the control group,with 53 cases in each group. The control group was operated according to conventional methods. And the observation group was peri-operatively injected tranexamic acid,with 10mg/（kg · h）. Results The intra-operative and post-operative dosages of FFB and red blood cell suspension were less in the observation group（P 0. 05）. The post-operative hospital stay and total drainage volume was less in the observation group too（P 0. 05）. But the operation time and CPB time had no difference（P 0. 05）. Comparing with the control group,it was significantly longer of the intra-operative and post-operative PT and APTT,and significantly more of the intra-operative and post-operative Pt and FIB in the observation group（P 0. 05）. Conclusion The application of tranexamic acid in extracorporeal circulation for open heart valve replacement is recommended with good protective effect,which can reduce the amount of blood loss and blood transfusion,and is worth popularizing in clinical application.