Chaudhary Farid Ahmad, Pervaz Zahid, Ilyas Sana, Niaz Muhammad Nabeel
Cardiothoracic Surgery, Rehmatul-lil-Alameen Institute of Cardiology, PESSI, University of Lahore.
Cardiac Surgery, Sheikh Zayed Hospital, Lahore.
J Pak Med Assoc. 2018 Apr;68(4):538-542.
To determine the efficacy of topical pouring of tranexamic acid in reducing post-operative mediastinal bleeding, requirement for blood products and the rate of re-exploration for re-securing haemostasis or relief of pericardial tamponade after open heart surgery.
The prospective, randomised, placebo-controlled, double-blind comparative study was conducted from March 2013 to September 2015 at Rehmatul-lil-Alameen Institute of Cardiology, Punjab Employees Social Security Institution, Lahore, and comprised patients scheduled for primary isolated elective or urgent open heart surgery. The subjects were divided into two equal groups. The hetranexamic acid group received cardiac bath with 2gm of tranexamic acid diluted in 50mlof normal saline, while the placebo group received cardiac bath without tranexamic acid. Before the closure of sternum, the solution was poured into pericardial cavity as cardiac bath while the chest tubes were temporarily clamped. Data was entered into a pre-designed proforma.
Of the 100 subjects, there were 50(50%) in each of the two groups. There was no difference in surgical characteristics and perioperative complications in the groups (p>0.05). After 48 post-operative hours, total blood loss was significantly less in the tranexamic acid group compared to the placebo group (p<0.05). Significantly less number of blood pints were transfused in the acid group than the placebo group (p<0.05). No patient in the acid group was re-explored for excessive bleeding compared to 4(8%) in the placebo group.
There was significant reduction in post-operative blood drainage, need of blood products and rate of re-exploration after topical use of tranexamic acid in open heart surgery.
确定局部灌注氨甲环酸在减少心脏直视手术后纵隔出血、血制品需求以及再次开胸止血或解除心包填塞的再次探查率方面的疗效。
2013年3月至2015年9月，在拉合尔旁遮普省雇员社会保障机构的雷赫马图勒 - 利勒 - 阿拉明心脏病学研究所进行了一项前瞻性、随机、安慰剂对照、双盲对比研究，纳入计划进行初次单纯择期或急诊心脏直视手术的患者。将受试者分为两组，每组人数相等。氨甲环酸组接受用2克氨甲环酸稀释于50毫升生理盐水中的心脏灌洗，而安慰剂组接受无氨甲环酸的心脏灌洗。在关闭胸骨前，当胸管暂时夹闭时，将溶液作为心脏灌洗倒入心包腔。数据录入预先设计的表格。
100名受试者中，两组各有50名（50%）。两组的手术特征和围手术期并发症无差异（p>0.05）。术后48小时后，氨甲环酸组的总失血量明显少于安慰剂组（p<0.05）。氨甲环酸组输注的血袋数量明显少于安慰剂组（p<0.05）。与安慰剂组的4名（8%）相比，氨甲环酸组没有患者因出血过多而接受再次探查。
心脏直视手术局部使用氨甲环酸后，术后引流量、血制品需求及再次探查率均显著降低。
