摘要
目的评价氨甲环酸(TXA)对房间隔缺损(ASD)患儿围术期的血液保护作用及对不良事件发生率和死亡率的近期与长期影响。方法回顾性队列研究:连续选取本院2009年1月—2010年12月接受ASD修补术的单纯ASD患儿224名,根据术中是否应用TXA被分TXA组(n=96)和对照组(n=128),年龄2个月—6(3.23±2.22)岁,美国麻醉师协会(ASA)分级为1—2级;在术后第7年电话随访患儿及其家属。记录并统计分析患儿主要的围术期出血和输血及术后近远期不良事件的发生率和死亡率。结果对照组和TXA组ASD患儿出血量(mL):术中59.83±2.11 vs 62.01±2.44(P>0.05),术后99.47±3.86 vs 85.97±4.46(P<0.05);输血量:红细胞(U)为0.08±0.02 vs 0.03±0.02、血浆(mL)为7.96±2.76 vs 5.02±3.19、血小板(mL)为0 vs 0(均为P>0.05);术后机械通气时间(h)为3.64±4.14 vs 3.35±1.91、ICU停留时间(d)为1.08±0.91 vs 0.99±0.85、术住院时间(d)为7.16±1.73 vs 7.14±1.78;术后远期肾功能衰竭发生率(%)为0 vs 0和死亡率(%)为0 vs 0 (均为P>0.05)。其中,TXA组和对照组术后远期痉挛的发生率为2.5%vs 0,有增加的趋势(P>0.05)。结论 TXA可有效降低ASD患儿的术后出血量,对围术期输血和近、远期不良事件的发生率和死亡率影响甚小。
Objective To evaluate the perioperative blood protective effect of tranexamic acid(TXA) on children with atrial septal defect(ASD), especially with respect to its impact on long-term effects. Methods The study was a retrospective cohort study. During January 2009 to December 2010, 224 consecutive patients(aged from 2 months to 6 years old) undergoing repair surgery for ASD in Fuwai Hospital were enrolled in the study. They were divided into two groups: the control group(n=128) and the TXA group(n=96). Patients and their families received telephone follow-up at 7 years after surgery. The amount of perioperative blood loss, allogeneic transfusion, short-term and long-term morbidity and mortality were recorded and analyzed. Results There was no significant difference in the intraoperative blood loss between the two groups((59.83±2.11)mL vs(62.01±2.44)mL, P>0.05)Compared with the control group, the patients in the TXA group were associated with significant decreased in postoperative blood loss((99.47±3.86)mL vs(85.97±4.46)mL, P<0.05)There were no significant differences among the amount of red blood cell[(0.08±0.02)U vs(0.03±0.02)U, P>0.05], fresh frozen plasma[(7.96±2.76)mL vs(5.02±3.19)mL, P>0.05], and platelet(0 U vs 0 U, P>0.05). There were no significant differences in the postoperative mechanical ventilation time(3.64±4.14 h vs 3.35±1.91 h), ICU stay(1.08±0.91 d vs 0.99±0.85 d), postoperative hospital length of stay(7.16±1.73 d vs 7.14±1.78 d), morbidity and mortality between the two groups(P>0.05). Moreover, Compared with the control group, the incidence of long-term seizure in the TXA group(2.5%) showed an increasing trend(P>0.05). Conclusion TXA can decrease postoperative blood loss significantly, but has little impact on the blood transfusion, short-term and long-term morbidity and mortality in ASD children undergoing surgery.
作者
张昱
高旭蓉
刘琳琳
石佳
袁素
陆海松
晏馥霞
ZHANG Yu;GAO Xurong;LIU Linlin;SHI Jia;YUAN Su;LU Haisong;YAN Fuxia(Department of Anesthesiology,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Transfusion,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)
出处
《中国输血杂志》
CAS
2018年第12期1372-1375,共4页
Chinese Journal of Blood Transfusion
关键词
氨甲环酸
房间隔缺损
小儿心脏手术
输血
围术期出血
术后不良事件
痉挛
tranexamic acid
atrial septal defect
pediatric cardiac surgery
blood transfusion
perioperative blood loss
postoperative adverse event
seizure
