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中国临床药理学与治疗学 ›› 2021, Vol. 26 ›› Issue (7): 830-835.doi: 10.12092/j.issn.1009-2501.2021.07.016

• 综述与讲座 • 上一篇    下一篇

心血管手术围术期抗纤溶治疗的有效性及安全性

李倩,吕红,刘岳,石佳   

  1. 中国医学科学院,北京协和医学院,国家心血管病中心,心血管疾病国家重点实验室,阜外医院麻醉中心,北京 100037 

  • 收稿日期:2021-01-05 修回日期:2021-07-22 出版日期:2021-07-26 发布日期:2021-08-09
  • 通讯作者: 石佳,男,博士,主任医师,硕士生导师,研究方向:心血管围术期管理与血液保护,临床大数据分析和风险预测模型。 Tel: 18511372012 E-mail: shiandypumc@sina.com
  • 作者简介:李倩,女,在读硕士研究生,研究方向:心血管围术期血液管理、脏器保护、风险预测模型等。 Tel: 17775112913 E-mail: liqian@fuwai.com
  • 基金资助:
    北京协和医学院研究生教学改革基金资助项目(2017E-JG03)

Efficacy and safety of antifibrinolytic therapy in the perioperative cardiovascular surgery

LI Qian, LV Hong, LIU Yue, SHI Jia   

  1. State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Anesthesia Center, Beijing 100037, China
  • Received:2021-01-05 Revised:2021-07-22 Online:2021-07-26 Published:2021-08-09

摘要: 大量出血和异体输血是心血管手术围术期常见的严重并发症,可显著增加不良临床事件的发生并恶化远期预后。围术期血液保护策略已在临床工作中得到广泛推广并应用,抗纤溶治疗作为围术期血液保护策略的核心内容,可显著减少心血管手术围术期出血和输血。在成人体外循环心脏手术中,丰富的临床试验已证实赖氨酸类似物作为抗纤溶药物在心血管手术围术期的有效性和安全性,然而抗纤溶药物在非体外循环心血管手术、小儿心血管手术中的有效性和安全性的循证医学证据仍然不足。此外,近年来亦有关于抗纤溶药物的局部使用及相关机制的报道。本文拟就心血管手术围术期抗纤溶治疗现状和进展作一综述。

关键词: 心血管手术, 抗纤溶治疗, 氨甲环酸

Abstract: Massive hemorrhage and allogeneic blood transfusion are common complications in the perioperative period of cardiovascular surgery, which can significantly increase the incidence of adverse events and worsen the long-term prognosis. Therefore, perioperative blood protection strategies have been widely promoted and applied in clinical practice. Additionally, as the core strategy, antifibrinolytic therapy can tremendously reduce perioperative bleeding and blood transfusion during cardiovascular surgery. Tremendous clinical trials have confirmed the efficacy and safety of lysine analog in adult cardiopulmonary bypass cardiac surgery. However, evidence-based medicine on the effectiveness and safety of antifibrinolytic drugs in off-pump cardiovascular surgery and pediatric cardiovascular surgery is still insufficient; there still needs further research and concern. In addition, the topical use of antifibrinolytic drugs and related molecular mechanisms have been reported in recent years. Therefore, this article reviews the efficacy and safety of perioperative antifibrinolytic therapy in cardiovascular surgery.

Key words: cardiac surgical procedures, antifibrinolytic therapy, tranexamic acid

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