摘要
目的:探讨氨甲环酸联合急性等容量血液稀释(ANH)对非体外循环冠脉旁路移植术(OPCABG)患者的影响。方法:择期OPCABG手术患者60例,ASA II～III级,年龄45～70岁,BMI20～23 kg/m^2,随机分为3组(n=20):对照组(C组)、氨甲环酸组(T组)、氨甲环酸联合ANH组(T+A组)。C组不做处理;T组于麻醉诱导后30 min内采用静脉注射负荷量20 mg/kg氨甲环酸,然后以10 mg·kg^(-1)·h^(-1)输注至术毕;T+A组采用氨甲环酸和ANH联合应用。依次记录术前和术毕、术后24 h Hb,红细胞压积(Hct),Plt,凝血酶原时间(PT)和国际标准化比值(INR)等凝血功能指标以及D-二聚体的变化,以及术后6、24h胸管引流量,记录术后24 h内异体红细胞和新鲜冰冻血浆输注等情况。结果:与C组比较,T组和T+A组术毕和术后24 h时D-二聚体浓度下降,术后胸管引流量、异体红细胞的使用率和使用量降低(P<0.05);各组间各时点Hb、Hct、Plt和INR差异无统计学意义(P>0.05)。与T组比较,T+A组术后胸管引流量、异体红细胞和血浆使用量降低(P<0.05)。3组未见住院期间死亡和相关并发症的发生。结论:氨甲环酸联合中度ANH可以产生协同节约用血的效果,对OPCABG手术患者凝血功能无明显影响。
AIM： To investigate the effect of tranexamic acid plus acute normovolemic hemodilu- tion （ANH） in off-pump coronary artery bypass grafting （ OPCABG ） patients. METHODS ： Sixty ASA physical status II-III patients, aged 45-70 years, with body mass index of 20-23 kg/m2, sched- uled for elective undergoing OPCABG were randomly divided into 3 groups （ n = 20 ） ： control group （group C ）, tranexamic acid group （ group T）, tranexamic acid combined with ANH group （group T ＋ A）. Group C received no treatment. After induc- tion of anesthesia, tranexamic acid 20 mg/kg was intravenously infused in 30 min followed by continu- ous infusion at 10 mg kg-1 h-1 until the end of op- eration in group T. Tranexamic acid was intrave- nously infused combined with ANH in group T ＋ A.Coagulation parameters such as Hb, Hct, Plt, PT, INR and D-dimer were recorded before operation, after operation and 24 h after operation, respective- ly. The volume of chest tube drainage was collected and recorded at 6 h and 24 h after operation. The transfusion of allogeneic red blood cells and fresh frozen plasma within 24 h were also recorded. RE- SULTS ： Compared with group C, the D-dimmer lev- el decreased significantly in group T and group T ＋ A right after the operation and 24 h after the opera- tion, and the volume of chest tube drainage as well as the requirement for transfusion of allogeneic red blood ceils were reduced （P 〈 0.05 ）. No significant changes were found in Hb, Hct, Pit and 1NR at each time point between all groups （P 〉 0.05 ）.Compared with group T, the volume of chest tube drainage and the requirement for transfusion of allo- geneie red blood cells were reduced （ P 〈 0.05 ） in group T ＋ A. No development of death and compli- cations during days of hospitalization was observed in the three groups. CONCLUSION：Tranexamie acid combined with ANH exhibit a synergistic effect of blood-saving and has no significant effect on coagu- lation function of patients undergoing OPCABG surgery.
出处
《中国临床药理学与治疗学》
CAS
CSCD
2017年第5期584-588,共5页
Chinese Journal of Clinical Pharmacology and Therapeutics
基金
宁波市科技局资助项目(2010C50028)
宁波市医学科技基金项目(2010A01)
