氨甲环酸对紫绀小儿心脏手术早期预后和费用的影响

The effect of tranexamic acid on early surgical outcomes and cost in cyanotic pediatric patients undergoing cardiac surgery

目的探讨氨甲环酸(TXA)对紫绀小儿心脏手术早期预后和费用的影响。方法回顾性分析2013年12月至2015年9月于本院接受法洛四联症(TOF)根治术的患者328例,年龄2个月～12岁,ASA分级(Ⅱ～Ⅲ)级。符合入选标准的患儿被分为两组:对照组为138名患儿围术期未接受任何抗纤溶治疗; TXA组为190名患儿术中接受50～80 mg/kg TXA。记录并分析患儿的临床资料,回归模型评估术中应用TXA与围术期出血和输血的相关性。结果一般线性回归分析显示术中出血量在两组患者间无统计学差异(P>0.05)。对照组和TXA组术后出血量分别为(156.66±7.04) ml和(130.91±5.99) ml,TXA组术后出血量相较于对照组减少,差异具有显著性(MD:25.75 ml,P=0.006)。围术期红细胞、血浆和血小板的输注量在两组患者间无统计学差异(P>0.05)。多元logistic回归显示围术期红细胞、血浆和血小板的输注率在两组患者间无统计学差异(P>0.05)。另外,术后机械通气时间、术后ICU停留时间、术后住院时间、术后肾功能衰竭的发生率、住院死亡率和住院花费在两组患者间无统计学差异(P>0.05)。结论 TXA可有效降低紫绀小儿心脏手术的术后出血,对围术期血制品的输注、术后肾功能衰竭的发生率、住院死亡率和住院费用没有影响。

Objective To evaluate the effect of tranexamic acid（ TXA） on early surgical outcomes and cost in cyanotic pediatric patients undergoing cardiac surgery. Methods An observational study was performed on 328 consecutive patients aged from 2 months to 12 years old who received radical surgery for tetralogy of fallot（ TOF） in Fuwai hospital during December 2013 to September2015. They were divided into two groups： the control group（ n = 138） and the TXA group（ n = 190）. The control group included pediatric patients who were treated with no antifibrinolytic agent during the operation. The TXA group included pediatric patients who received 50-80 mg/kg of TXA during the operation. The pediatric patients＇ major perioperative blood loss,any allogeneic transfusion,renal failure,mortality and cost were recorded and analyzed. Results General linear regression analysis revealed that there was no significant difference in the intraoperative blood loss between the two groups（ P〈0.05）. The volume of postoperative blood loss in the control group and the TXA group was（ 156.66±7.04） ml and（ 130.91±5.99） ml,respectively. Compared with control group,patients in the TXA group were associated with significantly decreased postoperative blood loss（ MD： 25.75 ml,P = 0.006）. There was no significant difference in the amount of allogeneic blood transfusion（ P〈0.05）. Multivariate logistic regression analysis revealed that there was no significant difference in the exposure of allogeneic blood transfusion（ P〈0. 05）. There were no significant differences in the postoperative ICU,postoperative mechanical ventilation time,postoperative hospital length of stay,renal failure mortality and cost between the two groups（ P〉0.05）. Conclusion TXA significantly decreased postoperative blood loss,but might not affect the allogeneic blood transfusion,in-hospital renal failure,mortality and cost in cyanotic pediatric patients undergoing cardiac surgery.