高海拔地区肝包虫肝部分切除术患者应用氨甲环酸对术中输血和术后血栓弹力图参数的影响

Effects of tranexamic acid on intraoperative blood transfusion and postoperative thromboelastogram parameters in patients with partial hepatic resection of hydatid hepatica at high altitude

目的探讨氨甲环酸(TXA)对高海拔地区(海拔≥2200m)肝包虫病肝部分切除术患者术中输血(量)和术后凝血功能的影响。方法从青海省人民医院包虫科2018年10月~2019年12月全身麻醉后行择期肝包虫肝部分切除术的患者44名,年龄(39.09±14.70)岁,男性19名、女性25名,ASA分级Ⅰ~Ⅲ级,Child-Pugh评分A~B级,术前凝血功能正常,随机均分为TXA注射组:术前30 min静脉注射TXA 10 mg/(kg·人),对照组:术前30 min静脉注射等体积的0.9%氯化钠注射液;静脉注射前和手术结束时各抽取患者动脉血3 mL/人,做血栓弹力图(TEG)检测;比较2组患者的术中失血量、输血量及手术前后的Plt、Hb与TEG参数,采用SPSS22.0统计学软件做统计学分析。结果TXA组与对照组术中出血量(mL)分别为300(200,1000)vs 1400(1000,2100),血浆输注量(mL)0(0,0)vs 380(0,575),红细胞悬液输注量(mL)0(0,400)vs 1200(800,600);术前TEG各参数相近(P>0.05);术后R时(min)分别为8.32±2.24 vs 10.78±2.67,K时(min)分别为2.80(2.10,3.30)vs 3.70(3.20,4.80),Angle角(°)分别为54.76±9.48 vs 43.70±9.02(P<0.05)。结论高海拔地区肝包虫肝部分切除术患者术前使用TXA能减少术中出血量、减少术中血浆及红细胞悬液的输注量、节约高海拔地区血液资源;明显改善患者TEG参数(即凝血功能)。

Objective To investigate the effects of tranexamic acid(TXA)on intraoperative blood transfusion(volume)and postoperative coagulation function in patients with partial hepatectomy for hepatic hydatid disease in high altitude area(altitude≥2500 m).Methods Forty-four patients[(39.09±14.70)years old,19 males and 25 females]underwent elective partial hepatectomy for hydatid after general anesthesia from October 2018 to December 2019 in the Department of Hydatid of Qinghai Provincial People’s Hospital,with ASA gradeⅠ~Ⅲ,Child Pugh grade A~B,and normal preoperative coagulation function.They were randomly divided into TXA injection group,who received intravenous injection of TXA 10 mg/(kg·person)(30 min before surgery),and control group,given a placebo needed the equal amounts of injected 0.9%sodium chloride(30 min before surgery).3 mL of arterial blood was extracted from each patient before intravenous injection and at the end of operation for TEG detection.The intraoperative blood loss and transfusion volume as well as Plt,Hb and TEG parameters before and after surgery were compared between the two groups,and statistical analysis was performed with SPSS22.0 statistical software.Results The volume of intraoperative blood loss(mL)in TXA group and control group was 300(200,1000)vs 1400(1000,2100),respectively;the units of plasma transfusion(mL)0(0,0)vs 380(0,575);the units of RBC suspension transfusion(mL)0(0,400)vs 1200(800,600).Preoperative TEG parameters of two groups were similar to each other(P>0.05).The postoperative R,K and Angle(°)of two groups was 8.32±2.24 vs 10.78±2.67,2.80(2.10,3.30)vs 3.70(3.20,4.80)and 54.76±9.48 vs 43.70±9.02,respectively(P<0.05).Conclusion TXA can significantly improve coagulation functions,as well as effectively reduce intraoperative blood loss and intraoperative blood transfusion in patients with partial hepatic resection of hydatid hepatica in high altitude area.