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心脏手术期间及术后不同氨甲环酸给药方式对凝血功能及术后失血量的影响

[Influence of different tranexamic acid administration methods during and after cardiac surgery on coagulation function and postoperative blood loss].

作者信息

Wang Jing-jie, Chen Guang-jun, Liu Wei, Huang Yu-guang, Luo Ai-lun, Miao Qi

机构信息

Department of Anesthesiology,PUMC Hospital, CAMS and PUMC, Beijing, China.

出版信息

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2013 Apr;35(2):145-9. doi: 10.3881/j.issn.1000-503X.2013.02.004.

Abstract

OBJECTIVE

To evaluate the influence of different tranexamic acid administration methods during and after cardiac surgery with cardiopulmonary bypass(CPB) on coagulation function and postoperative bleeding.

METHODS

Patients undergoing elective cardiac surgery with use of CPB (n=60) were randomized in a double-blind fashion to one of two treatment groups:group A(n=30) , administered with tranexamic acid 10 mg/kg (intravenous injection slowly before skin incision) , followed by infusion of normal saline until postoperative 12 hours;and group B(n=30) , administered with tranexamic acid 10 mg/kg(intravenous injection slowly before skin incision) , followed by infusion of tranexamic acid 1 mg/(kg·h) until postoperative 12 hours. Hemoglobin, platelet count, and coagulation function were assessed before anesthesia induction, after surgery, 8am next day and 24 hours after surgery. Bleeding, allogeneic blood transfusion, and fluid infusion during the postoperative 24 hours were recorded.

RESULT

No differences were found between groups in terms of coagulant function, postoperative bleeding, allogeneic blood transfusion, and fluid infusion(P>0.05) .

CONCLUSION

Compared with intraoperative administration alone, prolonged treatment with tranexamic acid after cardiac surgery shows no advantage because it can not further improve coagulant function, reduce bleeding, or reduce allogeneic blood transfusion.

摘要

目的

评估体外循环心脏手术期间及术后不同氨甲环酸给药方式对凝血功能及术后出血的影响。

方法

择期行体外循环心脏手术的患者(n = 60)以双盲方式随机分为两个治疗组:A组(n = 30),于皮肤切开前缓慢静脉注射氨甲环酸10 mg/kg,随后输注生理盐水直至术后12小时;B组(n = 30),于皮肤切开前缓慢静脉注射氨甲环酸10 mg/kg,随后以1 mg/(kg·h)的速度输注氨甲环酸直至术后12小时。在麻醉诱导前、术后、次日上午8点及术后24小时评估血红蛋白、血小板计数及凝血功能。记录术后24小时内的出血量、异体输血情况及液体输注量。

结果

两组在凝血功能、术后出血、异体输血及液体输注方面均无差异(P>0.05)。

结论

与仅术中给药相比,心脏手术后延长氨甲环酸治疗并无优势,因为它不能进一步改善凝血功能、减少出血或减少异体输血。

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