摘要
目的探讨不同剂量氨甲环酸(TA)对体外循环(CPB)瓣膜置换术患者凝血功能及出血量的影响。方法选取2015年3月—2019年3月120例行CPB心脏瓣膜置换术患者,以随机数字表法分为低剂量组(负荷量10 mg/kg,维持量10 mg/kg·h)、中剂量组(负荷量15 mg/kg,维持量15 mg/kg·h)、高剂量组(负荷量30 mg/kg,维持量20 mg/kg·h),每组各40例。比较各组手术时间、CPB时间、阻断时间、插管时间、ICU停留时间、住院时间、血制品输注情况、并发症发生情况及术后出血、血小板含量和凝血指标。结果3组患者的手术时间、CPB时间、阻断时间、插管时间、ICU停留时间、住院时间及各血制品输注情况指标之间,P>0.05。3组间患者术后8 h、24 h、48 h及总引流量,P<0.05,且两两比较显示,低剂量组患者的术后各时段引流量及总引流量均显著高于高剂量组[(338.51±169.37)mL vs.(249.57±124.16)mL,(603.66±239.51)mL vs.(415.36±233.28)mL,(683.51±247.19)mL vs.(512.62±248.46)mL,(741.59±289.45)mL vs.(526.91±257.64)mL,P均<0.05]。术后,3组患者的PT、APTT、INR及FIB指标均显著上升(P<0.05)。3组间患者的PT、INR及FIB指标,P<0.05,且经两两比较,中剂量组术后PT、FIB显著低于低剂量组[(13.97±2.18)s vs.(15.84±2.57)s,(3.78±1.28)g/L vs.(4.37±1.44)g/L],高剂量组术后的PT、INR、FIB显著低于低剂量组[(13.04±2.11)s vs.(15.84±2.57)s,(1.15±0.18)vs.(1.46±0.71),(3.07±1.02)g/L vs.(4.37±1.44)g/L,P均<0.05],高剂量组术后的FIB也显著低于中剂量组[(3.07±1.02)g/L vs.(3.78±1.28)g/L,P<0.05]。3组患者的并发症及不良事件发生情况(2.50%vs.2.50%vs.0.00%),P>0.05。结论CPB心脏瓣膜置换术中应用高剂量的TA可有效减少出血量,改善凝血功能,但并不能改善血制品输注情况,不同剂量TA对术后并发症和死亡率没有显著影响。
Objective To investigate the beneficial effects of different doses of tranexamic acid(TA)on blood coagulation and blood loss reduction in patients undergoing cardiac valve replacement surgery with cardiopulmonary bypass(CPB).Methods A total of 120 patients who underwent CPB cardiac valve replacement surgery from March 2015 to March 2019 were enrolled and randomly assigned into three designated groups,low-dose group(10 mg/kg of load dose,10 mg/kg·h of maintenance dose),medium-dose group(15 mg/kg of load dose,15 mg/kg·h of maintenance dose)and high-dose group(30 mg/kg of load dose,20 mg/kg·h of maintenance dose).There were 40 cases in each group.The duration of surgery,CPB time,block time,intubation time,ICU stay,hospital length of stay,blood componet transfused,complications,postoperation bleeding,platelet and coagulation parameters were compared among respective treatment groups.Results There were no significant differences in the duration of surgery,CPB time,block time,intubation time,ICU stay,hospital length of stay and blood component transfused among the three groups(P>0.05).At 8h,24h and 48 h after surgery,there were significant differences in total drainage volume among the three groups(P<0.05).After surgery,drainage volume at each time point and total drainage volume in low-dose group were significantly higher than those in high-dose group[(338.51±169.37)mL vs.(249.57±124.16)mL,(603.66±239.51)mL vs.(415.36±233.28)mL,(683.51±247.19)mL vs.(512.62±248.46)mL,and(741.59±289.45)mL vs.(526.91±257.64)mL,respectively,P<0.05].After surgery,PT,APTT,INR and FIB in the three groups significantly increased(P<0.05).The differences in PT,INR and FIB among the three groups were statistically significant(P<0.05).After surgery,PT and FIB in medium-dose group were significantly lower than those in low-dose group[(13.97±2.18)s vs.(15.84±2.57)s,(3.78±1.28)g/L vs.(4.37±1.44)g/L,respectively].PT,INR and FIB in high-dose group were significantly lower than those in low-dose group[(13.04±2.11)s vs.(15.84±2.57)s,(1.15±0.18)vs.(1.46±0.71),(3.07±1.02)g/L vs.(4.37±1.44)g/L,respectively,P<0.05].After surgery,FIB in high-dose group was significantly lower than that in medium-dose group[(3.07±1.02)g/L vs.(3.78±1.28)g/L,respectively,P<0.05].There was no significant difference in incidence of complications and adverse events among the three groups(2.50%vs.2.50%vs.0.00%,P>0.05).Conclusion The high-dose TA is effective in reducing blood loss and improving coagulation function,but not in decreasing the needs for blood produce transfusion in CPB heart valve replacement surgery.Different doses of TA shed no significant effects on postoperative complications and mortality.
作者
刘志成
勉玉洁
石佳
LIU Zhicheng;MIAN Yujie;SHI Jia(Department of Anesthe Siology,Qinghai Cardiovascular and Cerebrovascular Disease Hospital,Xining 810012,China;ICU,The Fourih people's Hospital of Qing Hai Pricince;Departrment of Anesthesiology,Fuwai Hospital of Chinese A cademy of Medical Sciences)
出处
《中国输血杂志》
CAS
2020年第4期352-355,共4页
Chinese Journal of Blood Transfusion
关键词
氨甲环酸
体外循环
心脏瓣膜置换术
tranexamic acid
cardiopulmonary bypass
cardiac valve replacement
