肝大部切除术、全身纤溶活性及氨甲环酸的影响
Major liver resection, systemic fibrinolytic activity, and the impact of tranexamic acid.
作者信息
Karanicolas Paul J, Lin Yulia, Tarshis Jordan, Law Calvin H L, Coburn Natalie G, Hallet Julie, Nascimento Barto, Pawliszyn Janusz, McCluskey Stuart A
机构信息
Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
出版信息
HPB (Oxford). 2016 Dec;18(12):991-999. doi: 10.1016/j.hpb.2016.09.005. Epub 2016 Oct 18.
BACKGROUND
Hyperfibrinolysis may occur due to systemic inflammation or hepatic injury that occurs during liver resection. Tranexamic acid (TXA) is an antifibrinolytic agent that decreases bleeding in various settings, but has not been well studied in patients undergoing liver resection.
METHODS
In this prospective, phase II trial, 18 patients undergoing major liver resection were sequentially assigned to one of three cohorts: (i) Control (no TXA); (ii) TXA Dose I - 1 g bolus followed by 1 g infusion over 8 h; (iii) TXA Dose II - 1 g bolus followed by 10 mg/kg/hr until the end of surgery. Serial blood samples were collected for thromboelastography (TEG), coagulation components and TXA concentration.
RESULTS
No abnormalities in hemostatic function were identified on TEG. PAP complex levels increased to peak at 1106 μg/L (normal 0-512 μg/L) following parenchymal transection, then decreased to baseline by the morning following surgery. TXA reached stable, therapeutic concentrations early in both dosing regimens. There were no differences between patients based on TXA.
CONCLUSIONS
There is no thromboelastographic evidence of hyperfibrinolysis in patients undergoing major liver resection. TXA does not influence the change in systemic fibrinolysis; it may reduce bleeding through a different mechanism of action. Registered with ClinicalTrials.gov: NCT01651182.
背景
肝切除术中发生的全身炎症或肝损伤可能导致高纤维蛋白溶解。氨甲环酸（TXA）是一种抗纤维蛋白溶解剂，可在多种情况下减少出血，但在肝切除患者中尚未得到充分研究。
方法
在这项前瞻性II期试验中，18例接受大肝切除术的患者被依次分配到三个队列之一：（i）对照组（无TXA）；（ii）TXA剂量I——静脉推注1 g，随后在8小时内输注1 g；（iii）TXA剂量II——静脉推注1 g，随后以10 mg/kg/小时持续输注直至手术结束。采集系列血样用于血栓弹力图（TEG）、凝血成分和TXA浓度检测。
结果
TEG未发现止血功能异常。肝实质离断后，纤溶酶-抗纤溶酶复合物（PAP）水平升高至峰值1106μg/L（正常0-512μg/L），然后在术后次日早晨降至基线水平。两种给药方案均在早期达到稳定的治疗浓度。基于TXA分组的患者之间无差异。
结论
接受大肝切除术的患者没有血栓弹力图证据表明存在高纤维蛋白溶解。TXA不影响全身纤维蛋白溶解的变化；它可能通过不同的作用机制减少出血。在ClinicalTrials.gov注册：NCT01651182。
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