氨甲环酸联合急性等容量血液稀释在非体外循环冠脉旁路移植术中的应用

中国临床药理学与治疗学 ›› 2017, Vol. 22 ›› Issue (5): 584-588.

氨甲环酸联合急性等容量血液稀释在非体外循环冠脉旁路移植术中的应用

李炎¹，张崧¹，周莹¹，漆勇¹，郭建荣²

¹ 宁波市医疗中心李惠利东部医院，台北医科大学宁波医疗中心麻醉科，宁波 315040，浙江； ²上海浦东新区公利医院麻醉科，上海 200135

收稿日期:2016-05-11 修回日期:2016-09-22 出版日期:2017-05-26 发布日期:2017-05-27
通讯作者: 张崧，男，硕士研究生，主治医师，研究方向：血液保护对重要脏器功能的影响。 Tel：13586570739 E-mail：zhangsong111@163.com
作者简介:李炎，男，本科，主治医师，研究方向：血液保护相关研究。 Tel：13484273102 E-mail：liyan3842534@163.com
基金资助:
宁波市科技局资助项目(2010C50028); 宁波市医学科技基金项目 (2010A01)

Application of tranexamic acid combined with acute normovolemic hemodilution in off-pump coronary artery bypass grafting

LI Yan ¹, ZHANG Song ¹, ZHOU Ying¹, QI Yong¹, GUO Jianrong ²

¹Department of Anesthesiology, Ningbo Medical Center Lihuili Eastern Hospital, Taipei Medical University Ningbo Medical Center，Ningbo 315040，Zhejiang, China; ²Department of Anesthesiology, Shanghai Pudong Gongli Hospital, Shanghai 200135, China

Received:2016-05-11 Revised:2016-09-22 Online:2017-05-26 Published:2017-05-27

摘要/Abstract

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，BMI 20～23 kg/m²，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、24 h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。

关键词: 氨甲环酸, 急性等容量血液稀释, 非体外循环冠脉旁路移植术, 凝血功能

Abstract:

AIM: To investigate the effect of tranexamic acid plus acute normovolemic hemodilution (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, scheduled 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 induction of anesthesia, tranexamic acid 20 mg/kg was intravenously infused in 30 min followed by continuous infusion at 10 mg·kg^-1·h^-1 until the end of operation in group T. Tranexamic acid was intravenously 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, respectively. 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. RESULTS:Compared with group C, the D-dimmer level decreased significantly in group T and group T+A right after the operation and 24 h after the operation, and the volume of chest tube drainage as well as the requirement for transfusion of allogeneic red blood cells were reduced (P<0.05). No significant changes were found in Hb, Hct, Plt and INR 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 allogeneic red blood cells were reduced (P<0.05) in group T+A. No development of death and complications during days of hospitalization was observed in the three groups. CONCLUSION: Tranexamic acid combined with ANH exhibit a synergistic effect of blood-saving and has no significant effect on coagulation function of patients undergoing OPCABG surgery.

Key words: tranexamic acid, acute normovolemic hemodilution, off-pump coronary artery bypass grafting, coagulation

中图分类号:

R614

李炎，张崧，周莹，漆勇，郭建荣. 氨甲环酸联合急性等容量血液稀释在非体外循环冠脉旁路移植术中的应用[J]. 中国临床药理学与治疗学, 2017, 22(5): 584-588.

LI Yan, ZHANG Song, ZHOU Ying, QI Yong, GUO Jianrong. Application of tranexamic acid combined with acute normovolemic hemodilution in off-pump coronary artery bypass grafting[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2017, 22(5): 584-588.

参考文献

［1］Biglioli P，Cannata A，Alamanni F，et al.Biological efects of of-pump vs.on-pump coronary artery surgery：Focus on infammation，hemostasis and oxidative stress［J］．Eur J Cardiothorac Surg，2003，24(2)：260-269．
［2］Cata JP， Wang H， Gottumukkala V，et al. Inflammatory response，immunosuppression，and cancer recurrence after perioperative blood transfusions［J］．Br J Anaesth，2013，110(5)：690-701．
［3］戴萍，车辑，张卫梅，等．心脏瓣膜置换术患者应用改良贮存式自体输血和异体输血的效果比较［J］．临床输血与检验，2014，16(2)：142-145．
［4］Karski JM， Dowd NP， Joiner R，et al.The effect of three different doses of tranexamic acid on blood loss after cardiac surgery with mild systemic hypothermia (32 degrees C)［J］.J Cardiothorac Vasc Anesth, 1998，12(6)：642-646．
［5］王古岩，石佳，杨静，等．氨甲环酸对非体外循环冠状动脉旁路移植术病人的血液保护作用［J］．中华麻醉学杂志，2011，31(1)：7-9．
［6］Homi HM，Yang H，Pearlstein RD，et al. Hemodilution during cardiopulmonary bypass increase cerebral infarct volume after middle cerebral artery occlusion in rats［J］．Anesth Analg，2004，99(4)：974-981．
［7］Defoe GR，Ross CS，Olmstead EM，et al．Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group［J］．Ann Thorac Surg，2001，71(3)：769-776．
［8］Licker M， Ellenberger C， Murith N，et al.Cardiovascular response to acute normovolaemic haemodilution in patients with coronary artery diseases： Assessment with transoesophageal echocardiography［J］．Crit Care Med，2005，33(3)：591-597．

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