不同时机应用氨甲环酸对体外循环心脏瓣膜手术患者凝血功能及出血量的影响

doi:10.12092/j.issn.1009-2501.2019.12.014

中国临床药理学与治疗学 ›› 2019, Vol. 24 ›› Issue (12): 1415-1420.doi: 10.12092/j.issn.1009-2501.2019.12.014

不同时机应用氨甲环酸对体外循环心脏瓣膜手术患者凝血功能及出血量的影响

喻君1，金孝岠1，郭建荣2，曹亚1，鲁美静1，常燕1，周玉梅1，周炜1

¹皖南医学院第一附属医院弋矶山医院麻醉科，芜湖 241001，安徽； ²上海市浦东新区第二军医大学附属公利医院麻醉科，上海 200000

收稿日期:2019-02-22 修回日期:2019-05-22 出版日期:2019-12-26 发布日期:2020-01-07
通讯作者: 金孝岠，男，本科，主任医师，教授，研究方向：麻醉与应激。 Tel:13505530523 E-mail:jinxj@163.com
作者简介:喻君，女，硕士研究生，主治医师，研究方向：围术期血液保护。 Tel:13695673510 E-mail:doctor.yu2@163.com
基金资助:
国家自然科学基金面上项目（81671919；81870147）

Clinical study on the blood conservation effect of different time application of tranexamic acid in patients with cardiac valve surgery undergoing cardiopulmonary bypass

YU Jun ¹，JIN Xiaoju ¹，GUO Jianrong²，CAO Ya ¹, LU Meijing ¹, CHANG Yan ¹, ZHOU Yumei ¹, ZHOU Wei ¹

¹ Department of Anesthesiology, the First Affiliated Hospital of Wannan Medical College, Wuhu 241001, Anhui, China; ²Department of Anesthesiology, Gongli Hospital Affliated to Second Military Medical University of Shanghai Pudong, Shanghai 200000, China

Received:2019-02-22 Revised:2019-05-22 Online:2019-12-26 Published:2020-01-07

摘要/Abstract

摘要：

目的:比较体外循环(cardiopulmonary bypass，CPB)下行心脏瓣膜置换术中不同时间点静注氨甲环酸对围术期患者血液保护的效果。方法:拟行择期心脏瓣膜置换术患者40例随机分为2组：A组和B组，每组20例。A组：肝素化后5 min通过中心静脉注射氨甲环酸负荷剂量15 mg/kg，再以10 mg·kg-1·h-1的剂量静脉泵注维持至手术结束；B组：体外循环转机结束，给予鱼精蛋白后10 min通过静脉注射氨甲环酸的负荷剂量15 mg/kg，再以10 mg·kg-1·h-1的剂量静脉泵注维持至手术结束。在4个不同时间（术前T1、手术结束时T2、术后次日晨T3、术后24 h T4）抽静脉血查凝血功能、血常规，记录术后次日晨T3、术后24 h T4的心包纵膈引流量，异体红悬以及血浆输入量。结果:A组比B组显著减少患者在术后第一日晨和术后24 h的心包纵膈引流量以及血浆输注量（P<0.05）。但是在凝血功能方面，除了在T2-4时点B组的D-二聚体（D-D）显著大于A组（P<0.05），T3时间点B组的APTT显著长于A组（P<0.05），T2时间点B组的FDP显著高于A组（P<0.05）以外，所有其他时点凝血功能指标比如凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、国际标准化比值（INR）、纤维蛋白原（FIB）、纤维蛋白（原）降解产物（FDP），组间比较均未见统计学差异（P>0.05）。围术期所有时点的血红蛋白（HB）、红细胞压积（HCT）、血小板（PLT）结果在两组间比较也未见统计学差异（P>0.05）。两组患者的异体红悬输注量、液体输入量与尿量比较未见统计学差异（P>0.05），但在T3-4时点B组心包纵膈引流量和异体血浆的需求量显著多于A组（P<0.05）。结论:心脏瓣膜置换术的患者在体外循环转机之前使用氨甲环酸可以减少心脏手术术后早期心包纵膈引流量，在一定程度上减少异体血制品的输注。

关键词: 氨甲环酸, 血液保护, 体外循环, 心脏瓣膜置换术

Abstract:

AIM: To investigate the effect of different time of tranexamic acid on blood protection in patients undergoing cardiac valve replacement under the condition of cardiopulmonary bypass (CPB). METHODS: Forty patients undergoing cardiac valve replacement were randomly divided into two groups: group A (n=20) and group B (n=20). Group A received 15mg/kg tranexamic acid via central vein 5 minutes after heparinize. Group B received 15 mg/kg tranexamic acid intravenously 10 minutes after protamine injection at the end of cardiopulmonary bypass (CPB), and then 10 mg·kg-1·h-1 tranexamic acid was continuous intravenous infused until the end of the operation in the both groups. The venous blood samples were taken before operation T1, at the end of operation T2, and at the morning of after operation T3, 24 hours after operation T4. Then the coagulation indexes and the blood routine of the two groups were analyzed. The volume of pericardial mediastinal drainage, allogeneic erythrocyte red suspension and plasma input were recorded at T3 and T4. RESULTS:Compared with group B, group A could reduce pericardial mediastinal drainage and plasma infusion. But in terms of coagulation function, the APTT in group B at T3 time point was significantly longer than that in group A, the DD in group B at T2-4 time point and the FDP in group B at T2 time point was significantly higher than that in group A as well. No significant differences were found in all the other coagulation indexes (PT,APTT,INR,FIB,FDP) and blood routine (HB,HCT,PLT) between the two groups during perioperative period. There were no significant differences in the volume of allogeneic red suspension infusion between the two groups, but the volume of pericardial mediastinal drainage and the demand of allogeneic plasma in group B were significantly more than those in group A at T3-4. CONCLUSION:When tranexamic acid is intravenous medicated before CPB in patients undergoing cardiac valve replacement, tranexamic acid can reduce postoperative pericardial mediastinal drainage and allogeneic plasma infusion, and better inhibit hyperfibrinolysis.

Key words: tranexamic acid, blood protection, cardiopulmonary byass, cardiac valve replacement

中图分类号:

R614

喻君，金孝岠，郭建荣，曹亚，鲁美静，常燕，周玉梅，周炜. 不同时机应用氨甲环酸对体外循环心脏瓣膜手术患者凝血功能及出血量的影响[J]. 中国临床药理学与治疗学, 2019, 24(12): 1415-1420.

YU Jun，JIN Xiaoju，GUO Jianrong，CAO Ya, LU Meijing, CHANG Yan, ZHOU Yumei, ZHOU Wei1. Clinical study on the blood conservation effect of different time application of tranexamic acid in patients with cardiac valve surgery undergoing cardiopulmonary bypass[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2019, 24(12): 1415-1420.

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不同时机应用氨甲环酸对体外循环心脏瓣膜手术患者凝血功能及出血量的影响

Clinical study on the blood conservation effect of different time application of tranexamic acid in patients with cardiac valve surgery undergoing cardiopulmonary bypass

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