Patel Jigar, Prajapati Mrugesh, Patel Hardik, Gandhi Hemang, Deodhar Shilpa, Pandya Himani
1 Department of Cardiac Anesthesia, UN Mehta Institute of Cardiology and Research Center Ahmedabad, Gujarat, India.
2 Department of Medical Officer, UN Mehta Institute of Cardiology and Research Center Ahmedabad, Gujarat, India.
Asian Cardiovasc Thorac Ann. 2017 Feb;25(2):118-122. doi: 10.1177/0218492316688416. Epub 2017 Jan 9.
Background Coagulopathy is a major problem in surgery for cyanotic congenital heart disease. Tranexamic acid has been used both topically and systemically and plays a vital role in pediatric cardiac surgery by reducing blood loss and blood product requirement. We aimed to determine the anti-fibrinolytic effectiveness of low-dose systemic or topical tranexamic acid or a combination of both. Methods Seventy-five patients were divided in 3 groups of 25. Group A patients were given tranexamic acid 20 mg kg intravenously after sternotomy and 20 mg kg after heparin reversal. Group B patients were given tranexamic acid 50 mg kg in 20 mL of saline intrapericardially before sternal closure, with the drain clamped for 20 min. Group C patients were given tranexamic acid 20 mg kg intravenously after sternotomy and 50 mg kg intrapericardially before sternal closure. A number of clinical variables were recorded in the first 3 postoperative days. Ventilator time, intensive care unit stay, and outcome were also recorded. Results Chest tube drainage and blood product requirements were lowest in group C. Blood urea and serum creatinine levels were higher in groups A and C ( p < 0.05). Intensive care unit stay and ventilator time were similar in all 3 groups. No patient died and none had a seizure or other neurological event or thromboembolic complication postoperatively. Conclusion The combination of low-dose intravenous and topical tranexamic acid reduces postoperative blood loss and blood product requirement without incurring neurological, renal or thromboembolic complications. We recommend the routine use of topical and low-dose systemic tranexamic acid in cyanotic pediatric cardiac surgery.
凝血功能障碍是法洛四联症等先天性心脏病手术中的一个主要问题。氨甲环酸已被局部和全身使用，并通过减少失血和血液制品需求在小儿心脏手术中发挥重要作用。我们旨在确定低剂量全身或局部使用氨甲环酸或两者联合使用的抗纤溶效果。方法：75例患者分为3组，每组25例。A组患者在胸骨切开术后静脉注射氨甲环酸20mg/kg，肝素逆转后再注射20mg/kg。B组患者在胸骨闭合前在心包内给予20mL生理盐水中含氨甲环酸50mg/kg，引流管夹闭20分钟。C组患者在胸骨切开术后静脉注射氨甲环酸20mg/kg，胸骨闭合前在心包内注射50mg/kg。记录术后前3天的一些临床变量。还记录了呼吸机使用时间、重症监护病房停留时间和结局。结果：C组胸腔引流管引流量和血液制品需求量最低。A组和C组的血尿素和血清肌酐水平较高（p<0.05）。所有3组的重症监护病房停留时间和呼吸机使用时间相似。术后无患者死亡，无癫痫发作或其他神经系统事件或血栓栓塞并发症。结论：低剂量静脉和局部使用氨甲环酸联合可减少术后失血和血液制品需求，且不会引发神经、肾脏或血栓栓塞并发症。我们建议在小儿法洛四联症心脏手术中常规使用局部和低剂量全身氨甲环酸。
