术前应用氨甲环酸对行体外循环手术先天性心脏病患儿的血液保护作用

Effect of preoperative administration of tranexamic acid on blood conservation in congenital heart disease children undergoing cardiopulmonary bypass surgery

目的探讨术前应用氨甲环酸对行体外循环手术先天性心脏病患儿的血液保护作用。方法将178例先天性心脏病患儿随机分为氨甲环酸组101例、对照组77例。所有患儿均在体外循环下行心内畸形矫治术。在手术开始前30 min,氨甲环酸组单次输注25 mg/kg氨甲环酸,对照组输注等容生理盐水。于术前、术后24 h,检测患儿血红蛋白水平、血小板计数、凝血酶原国际标准化比值(INR);记录患儿术后总引流量、二次开胸情况、血液制品输注情况、并发症及围手术期死亡发生情况。结果术后24 h,两组血红蛋白水平、血小板计数均较术前下降,而INR较术前升高,但氨甲环酸组血红蛋白水平、血小板计数均高于对照组,INR低于对照组(均P<0.05)。氨甲环酸组患儿术后总引流量、红细胞悬液输注量及血浆输注量均少于对照组(均P<0.05);两组患儿的血小板输注量、术后并发症发生率、二次开胸率、围手术期病死率比较,差异均无统计学意义(均P>0.05)。结论体外循环先天性心脏病手术术前应用氨甲环酸,可减少患儿术后的引流量及输血量,并可促进凝血功能的恢复,具有血液保护作用。

Objective To explore the effect of preoperative administration of tranexamic acid on blood conservation in congenital heart disease children undergoing cardiopulmonary bypass surgery.Method A total of 178 children with congenital heart disease were randomized into tranexamic acid group(101 cases)and control group(77 cases).All the children underwent corrective surgery for intracardiac malformation under cardiopulmonary bypass.Before 30 minutes of operation,the tranexamic acid group and control group received single fusion of tranexamic acid(25 mg/kg)and normal saline with equal volume,respectively.Before operation and after 24 hours of operation,hemoglobin level,platelet count and prothrombin international normalized ratio(INR)were measured in the children;the total postoperative drainage volume,incidence of re-thoracotomy,infusion of blood products,and incidence of complications and perioperative death of the children were recorded.Result After 24 hours of operation,hemoglobin level and platelet count declined but INR increased in both groups as compared with the preoperation,whereas the tranexamic acid group obtained higher hemoglobin level and platelet count as well as lower INR than the control group(all P<0.05).The total postoperative drainage volume,fusion volumes of RBC suspension and plasma in the tranexamic acid group were less than those in the control group(all P<0.05);there were no statistically significant differences between the two groups in platelet fusion volume,incidence rate of postoperative complications,rate of re-thoracotomy and perioperative fatality rate(all P>0.05).Conclusion Application of tranexamic acid before cardiopulmonary bypass surgery for congenital heart disease can reduce the postoperative drainage volume and blood fusion volume of children,and promote the recovery of coagulation function,thereby exerting an effect on blood conservation.