氨甲环酸在体外循环冠状动脉旁路移植术中的应用

Application of tranexamic acid in off-pump coronary artery bypass grafting surgery

目的分析氨甲环酸在体外循环冠状动脉旁路移植术中的应用及其安全性研究。方法选取2013年2月至2015年2月期间新疆维吾尔自治区人民医院收治的100例体外循环冠状动脉旁路移植术患者,采取随机分组方式将其均分为实验组和对照组,每组50例,实验组氨甲环酸剂量和维持量分别为10 mg/kg、2 mg.kg^(-1).h^(-1);对照组氨甲环酸剂量和维持量分别为30 mg/kg、15 mg.kg^(-1).h^(-1)。观察并对比两组患者术中红细胞、血小板、血浆、凝血功能,术后胸管引流量及不良反应等。结果对照组麻醉诱导前(T0)、手术结束时(T1)及手术后(T2)各时间点血红蛋白浓度、血小板、活化凝血时间、国际标准化比值、纤维蛋白原浓度均明显大于实验组,差异具有统计学意义(P<0.05)。结论在体外循环冠状动脉旁路移植术中,小剂量的氨甲环酸能更好地对患者血浆进行保护,其安全性和有效性更高,因此,在临床治疗中,针对体外循环冠状动脉旁路移植术应尽量选择小剂量的氨甲环酸进行治疗。

Objectives To analyze the efficacy and safety of application of tranexamic acid in off-pump coronary artery bypass grafting（CABG）surgery. Methods Totally 100 patients who underwent off-pump CABG surgery during Feb-ruary 2013 to Februrary 2015 in Xinjiang Uygur Autonomous Region People ＇s Hospital were selected. They were ran-domly divided into observation group and control group ,50 cases in each group. Tranexamic acid dose and maintenance dose of observation group were 10 mg/kg,2 mg.kg^-1.h^-1 and 30 mg/kg,15 mg. kg^-1.h^-1 in control group. Red blood cell, platelet,plasma,magnitude of blood coagulation function,postoperative chest tube drainage and adverse reactions were observed between the two groups. Results Hemoglobin concentration,platelets,activation coagulation time,in-ternational normalized ratio,protein fiber in control group before induction of anesthesia（T0）,at the end of operation （T1）and after surgery（T2）were significantly higher than those of observation group（P〈0.05）. Conclusions In off-pump CABG surgery ,small dose of tranexamic acid can better protect on plasma with higher safety and effectiveness. There-fore,in clinical treatment,for off-pump CABG surgery, doctors should try to choose a small dose of tranexamic acid.