摘要
目的研究氨甲环酸在非体外循环冠脉搭桥手术(OPCABG)中的应用效果。方法选择OPCABG患者60例,随机分为A组(氨甲环酸组)与B组(对照组),每组30例,在切皮时分别开始静脉缓慢滴注氨甲环酸20 mg/kg和等量的0.9%氯化钠溶液,时间大于30 min,记录围术期出血量、输血情况、D-二聚体以及其他相关凝血功能指标、肾功能指标的变化和过敏反应的发生情况。结果术中平均失血量、输血人数以及术毕心包和纵隔引流量A组少于B组,差异有统计学意义;两组术后D-二聚体值均明显增加,但A组增加程度明显小于B组(P<0.05);术后引流量、输血量与B组比较未见显著性差异;两组凝血酶原时间(PT)和部分活化凝血酶时间(APTT)术后无显著延长(P>0.05);组间比较亦无显著性差异;纤维蛋白原(Fib)B组术后比术前显著降低(P<0.05),A组则无显著性变化;两组血小板数量均明显降低,组内差异显著,组间无显著差异。两组患者均未发生术后严重低血压、异常出血、肾功能不全以及过敏反应。结论 OPCABG术中应用氨甲环酸可减少术中出血量,抑制术后纤溶亢进,改善术后早期低凝状态。
Objective To investigate the effect of tranexamic acid on off - pump coronary artery bypass graft- ing. Methods We performed off-pump coronary artery bypass grafting in 60 cases. These patients were randomly di- vided into group A （tranexamic acid group） and group B （placebo group） with 30 cases in each group. Tranexamic acid （20 mg/kg） and equal volume of 0. 9% sodium chloride solution were administered by intravenous drip for more than 30 rain before skin incision. We observed the blood loss in perioperation, blood transfusion, D - Dimer, coagulation in- dex, kidney function, and allergic reaction. Results We found that group A had significantly less blood loss, blood transfusion, and postoperative mediastinal and pericardiac drainage than group B. D - Dimer were obviously increased in both group, and increased D - Dimer of group A was significantly lower than that in group B （P 〈 0. 05）. There was no statistic difference in postoperati,~e drainage and blt^od transfusitm between two groups. We didn＇t find expand of pro- thrombin time （PT） and activated partial thromoplastin time （APTT） in both groups. Fibrinogen （Fib） in group B sig- nificantly reduced after operation （P 〈 0. 05 ）, while there was no change in group A. We also found that the platelet count decreased in all cases, though differences were significant within each group and no differences were found between them. There was no severe hypotension, abnormal bleeding, renal dysfunction, and allergic reaction occurred after oper- ation in both groups. Conclusions Application of tranexamic acid during off - pump coronary artery bypass grafting could reduce blood loss, inhibit hyperfibrinolysis and protect the early stage of low coagulation state postoperation.
出处
《航空航天医学杂志》
2015年第6期678-680,共3页
Journal of Aerospace medicine
关键词
氨甲环酸
非体外循环冠脉搭桥术
凝血
纤溶
tranexamic acid
off-pump coronary artery bypassgraft
coagulation
fibrinolysis
