心脏手术后血液透析患者氨甲环酸作用持续时间长：1 例报告。
Long Duration of Action of Tranexamic Acid After Cardiac Surgery in a Hemodialysis Patient: A Case Report.
机构信息
From the Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
出版信息
A A Pract. 2023 May 5;17(5):e01676. doi: 10.1213/XAA.0000000000001676. eCollection 2023 May 1.
A 61-year-old woman with chronic renal dysfunction was scheduled to undergo aortic valve replacement. After a bolus of 1 g tranexamic acid (TXA), the TPA (tissue-plasminogen activator)-test result with the ClotPro system demonstrated extensive inhibition of fibrinolysis. Plasma TXA level decreased from 71 to 25 μg/dL at 6 hours postoperatively; however, no further decrease was observed. Although TXA levels dropped to 6.9 μg/dL after hemodialysis on postoperative day (PoD) 1, fibrinolytic shutdown on the TPA-test remained unchanged until PoD 2. In dialysis patients, low-dose TXA <1 g may be considered for reducing seizure and thromboembolic complications after cardiac surgery.
一位 61 岁患有慢性肾功能障碍的女性计划接受主动脉瓣置换术。给予 1 克氨甲环酸（TXA）的推注后，ClotPro 系统的 TPA（组织纤溶酶原激活物）检测结果显示纤溶抑制广泛。术后 6 小时，血浆 TXA 水平从 71 降至 25μg/dL；但未再下降。虽然术后第 1 天行血液透析后 TXA 水平降至 6.9μg/dL，但 TPA 检测的纤溶抑制状态直至术后第 2 天仍未改变。对于透析患者，可考虑使用小剂量 TXA <1 g，以减少心脏手术后的癫痫发作和血栓栓塞并发症。
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