Sabry Mohab M, Sallam Ayman A, Elgebaly Ahmed Said, Abdelwahab Amr A
Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt.
Department of Anesthesia and Post-Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt.
Ann Card Anaesth. 2018 Oct-Dec;21(4):409-412. doi: 10.4103/aca.ACA_231_17.
During decortication surgery, fibrous peel over the lung was removed to allow expansion of the lung and therefore, wide raw area was created with surface oozing. The phenomenon of fibrinolysis usually activated after such procedure, resulting in increasing the postoperative bleeding. Tranexamic acid is one of antifibrinolytic therapies that could be used topically and to targets directly the source of bleeding and reducing the local activation of the fibrinolytic process and consequently reducing the postoperative bleeding.
A total of 70 patients underwent lung decortication surgery in Cardiothoracic Surgery Department at Tanta University Hospital from January 2015 to May 2017. Patients were randomly allocated into two groups, Group I (35 patients) receiving 3 g of tranexamic acid in 100 ml of saline solution and Group II (35 patients) receiving 100 ml of saline solution as placebo. At the end of the operation and before closing the chest, in both groups, drug or placebo solution was distributed locally all over the pleural cavity. Comparison between the groups was done regarding the amount of postoperative bleeding, postoperative hemoglobin in the first 24 and 48 h postoperatively, blood transfusion, Intensive Care Unit (ICU) stay, and hospital stay.
Both groups were comparable regarding demographic and surgical data. Group I patients had the significantly lesser amount of postoperative blood loss than Group II during the first postoperative 48 h, and hence, the need of postoperative blood transfusion was significantly lower in Group I with better postoperative hemoglobin level than Group II. However, there was no difference in overall ICU and hospital stay.
The local intrapleural use of tranexamic acid after decortication surgery of the lung is safe and significantly reduces the amount of postoperative blood loss and in consequence reduces the amount of postoperative blood transfusion.
在去纤维蛋白膜剥脱手术中，需切除肺表面的纤维性包膜以使肺得以扩张，因此会形成大面积的创面并有渗血。此类手术后通常会激活纤维蛋白溶解现象，导致术后出血增加。氨甲环酸是一种抗纤维蛋白溶解疗法，可局部使用，直接作用于出血源，减少纤维蛋白溶解过程的局部激活，从而减少术后出血。
2015年1月至2017年5月期间，共有70例患者在坦塔大学医院心胸外科接受了肺去纤维蛋白膜剥脱手术。患者被随机分为两组，第一组（35例患者）接受100毫升盐溶液中含3克氨甲环酸，第二组（35例患者）接受100毫升盐溶液作为安慰剂。在手术结束且关闭胸腔前，两组均将药物或安慰剂溶液局部注入整个胸腔。比较两组患者的术后出血量、术后第1个24小时和48小时的血红蛋白水平、输血情况、重症监护病房（ICU）住院时间及住院总时间。
两组在人口统计学和手术数据方面具有可比性。术后48小时内，第一组患者的术后失血量明显少于第二组，因此，第一组术后输血需求明显低于第二组，且术后血红蛋白水平优于第二组。然而，两组在ICU总住院时间和住院总时间方面并无差异。
肺去纤维蛋白膜剥脱手术后局部胸腔内使用氨甲环酸是安全的，可显著减少术后失血量，进而减少术后输血量。
