[摘要] 目的:观察冠状动脉旁路移植术(coronary artery bypass graft,CABG)后应用氨甲环酸(tranexamic acid, TA)对术后出血的治疗效果。方法:选择2006年6月～2009年10月在本院接受CABG的60例患者,将其随机分为氨甲环酸组(31例)和对照组(29例),在CABG术前和术中分别静脉注射氨甲环酸和等量的0.9%氯化钠溶液,观察TA在CABG后24 h对总失血量和输血量的影响及术前和术后3 h D-dimer水平的变化。结果:CABG术后24 h氨甲环酸组的总失血量(450±205) ml显著少于对照组(863±343) ml,且术中输血量TA组显著少于对照组。术后对照组的血浆D-dimer水平显著增加,而TA组的D-dimer水平无显著变化。结论:与对照组相比,氨甲环酸可以发挥抗纤溶作用,并能够有效地降低CABG术后出血。
[关键词] 冠状动脉旁路移植术;氨甲环酸;术后出血
[中图分类号] R973 [文献标识码]B [文章编号]1674-4721(2010)07(a)-061-02
Tranexamic acid reduces postoperative bleeding in coronary artery bypass graft
REN Mingming,HAN Zhen,LI Jinglai,CHENG Ying,WU Yongqian
(Department of Cardiovascular Surgery of Peking University Shenzhen Hospital,Guangdong Province,Shenzhen 518036,China)
[Abstract] Objective:To evaluate the treatment effect of tranexamic acid reduces postoperative blood loss in coronary artery bypass surgery. Methods: 60 patients undergoing coronary artery bypass graft (CABG) from June 2006 to October 2009 in department of cardiac surgical were randomly selected and enrolled into the study, and divided into tranexamic acid (TA) group(31 patients) and placebo group(29 patients), the TA group received an intravenous TA before the skin incision and followed by a continuous infusion, the placebo group received an identical syringe of normal saline solution. The effect of TA reduced total blood loss in 24 h and the blood transfusion were observed. Also observed the change of D-dimer level. Results: 24 hours postoperative blood loss was significantly less in the tranexamic acid group(450±205) ml than that of the placebo group(863±343) ml, and the intraoperative blood transfusion in TA group was significantly less than that of placebo group. There was significant increase in plasma D-dimer levels after CABG only in patients of the placebo group, whereas no significant changes were observed in the group treated with tranexamic acid. Conclusion: Compare to the placebo group, trannexamic acid may play a role in anti-fibrinolytic and appears to be effective in reducing the postoperative blood loss.
[Key words] Coronary artery bypass graft(CABG); Tranexamic acid(TA); Postoperative bleeding
冠状动脉粥样硬化性心脏病严重危害人类健康,其治疗可施行冠状动脉旁路移植术(CABG),又被称为冠脉搭桥术(CHD)。虽然心脏外科的安全性在不断地发展完善,但心肺分流术后的失血过多,仍然是术后并发症的主要原因之一。纤维蛋白降解产物活性增加和血小板功能障碍被认为是CABG术后出血的重要因素。抗纤溶药物被用来预防血小板的功能障碍和减少术中出血。最近,氨甲环酸(TA)作为一种可选择的抑肽酶药物受到了越来越多的关注。氨甲环酸可通过降低纤溶酶对血小板糖蛋白受体的作用来保护血小板的功能。本研究观察经过氨甲环酸和对照处理的冠状动脉旁路移植术后总失血量及输入红细胞单位和百分比的变化,探讨TA对冠状动脉旁路移植术后出血的影响。
1 资料与方法
1.1 一般资料
2006年6月～2009年10月,在本院心脏外科接受CABG的患者60例,其中,男39例,女21例,年龄56～75岁,平均65岁。患者被随机分为氨甲环酸组和对照组,排除标准包括二次心脏手术、肾功能不全(血浆肌酐浓度高于2 mg/kg)、血液病病史、肝功能障碍或手术后抗血小板治疗7 d内。两组患者的年龄、性别、重量、身高、前壁心肌梗死的例数、糖尿病和有高血压病史的例数等方面,差异无统计学意义(P>0.05)。两组一般资料比较见表1。
1.2 研究方法
符合标准的患者被随机分为TA组和对照组,TA组在术前给予静脉注射10 mg/kg的TA,且术中给予1 mg/(kg・h)持续5 h。对照组用相同的注射器给予0.9%氯化钠溶液持续给药5 h,且两组的液体入量相同。两组患者在手术室手术和ICU护理时均未告知以上处理。
1.3 观察指标
临床观察在CABG术中和术后24 h内,两组患者的总输血量、血红蛋白浓度、术中输入血红蛋白的百分比和术中进行输血的例数、术前和术后3 h内由桡动脉留置导管采动脉血样,测定D-dimer水平。
1.4 统计学方法
数据处理采用SPSS 13.0软件,计量资料以均值±标准差表示,使用t检验,计数资料使用χ2检验,P0.05);氨甲环酸组和对照组的总失血量、输入血红蛋白百分比和术中输血的例数,差异均有统计学意义(P