Maddali Madan M, Rajakumar Muthukkumar C
Department of Anesthesia, Royal Hospital, Seeb, Muscat, Sultanate of Oman.
Asian Cardiovasc Thorac Ann. 2007 Aug;15(4):313-9. doi: 10.1177/021849230701500410.
Tranexamic acid was used to reduce postoperative drainage and allogenic blood transfusion requirements in patients undergoing on-pump primary coronary bypass surgery. Over 12 months, 222 patients participated in this prospective, randomized, placebo-controlled, double-blind study conducted at a tertiary center. Half of the patients were randomly allocated to receive tranexamic acid as a bolus (10 mg x kg(-1)) prior to sternotomy, followed by an infusion (1 mg x kg(-1) x hr(-1)) up to the time of starting of protamine. The other 111 patients received a saline bolus and infusion. Postoperative drainage and transfusion requirements were measured in all patients. Markers of graft patency, hemostasis, hemodynamic stability, and fibrinolysis were evaluated. Chest closure time, renal function parameters, allergic reactions, incidence of stroke, re-exploration, and hospital mortality were also noted. Postoperative drainage was significantly less and blood conservation considerably better when tranexamic acid was used. Post-bypass hemostasis was achieved faster, fibrinolysis was less, and there was no evidence of increased incidence of graft occlusion in the group given tranexamic acid.
氨甲环酸用于减少接受体外循环下初次冠状动脉搭桥手术患者的术后引流量和异体输血需求。在12个月的时间里，222例患者参与了在一家三级中心进行的这项前瞻性、随机、安慰剂对照、双盲研究。一半患者被随机分配在胸骨切开术前接受氨甲环酸推注（10 mg×kg⁻¹），随后持续输注（1 mg×kg⁻¹×hr⁻¹）直至开始使用鱼精蛋白时。另外111例患者接受生理盐水推注和输注。测量所有患者的术后引流量和输血需求。评估移植物通畅性、止血、血流动力学稳定性和纤维蛋白溶解的标志物。还记录了关胸时间、肾功能参数、过敏反应、中风发生率、再次手术和医院死亡率。使用氨甲环酸时，术后引流量显著减少，血液保护效果明显更好。接受氨甲环酸治疗的组旁路术后止血更快，纤维蛋白溶解更少，且没有证据表明移植物闭塞发生率增加。
