Shore-Lesserson L, Reich D L, Vela-Cantos F, Ammar T, Ergin M A
Department of Anesthesiology, Mount Sinai Medical Center, New York, New York 10029, USA.
Anesth Analg. 1996 Jul;83(1):18-26. doi: 10.1097/00000539-199607000-00005.
The administration of tranexamic acid (TA) prior to cardiopulmonary bypass (CPB) has been associated with reduced bleeding during and after cardiac surgery. In a prospective, randomized, controlled, double-blind clinical trial, adult patients undergoing repeat open heart surgery received TA (n = 17) or an equal volume of saline placebo (n = 13). In the TA group, a 20-mg/kg intravenous (IV) initial dose of TA at akin incision was followed by an infusion of 2 mg.kg-1.h-1, which continued for the duration of the surgical procedure. Identical transfusion guidelines were followed in both groups. Routine coagulation tests, D-dimer levels, mediastinal tube drainage, and transfusion requirements were compared. Cumulative postoperative mediastinal tube drainage measured at 24 h was 649 +/- 391 mliter (mean +/- SD) in the TA group compared with 923 +/- 496 mliter in the placebo group (P < 0.01). Forty-eight-and 72-h mediastinal tube drainage were also significantly less in the TA group (P < 0.01). Seven of 17 TA patients received to transfusion of allogeneic blood products compared with 1 of 13 placebo patients (P = 0.047). The incidence and volumes of platelet and fresh frozen plasma transfusion in the TA group were not significantly different in comparison with the placebo group. The perioperative increase in D-dimer levels (post-CPB minus pre-CPB) in the placebo group (median difference = 675 ng/mliter, range 125-1648) was significantly more than in the TA group (median difference = 182 ng/mliter, range -426-1950; P = 0.003). Sternal closure occurred in 41 +/- 21 min in the TA group and 61 +/- 49 min in the placebo group (P = 0.14), and the subjective bleeding score was less in the TA group than in the placebo group (2.38 +/- 0.78 vs 3.08 +/- 1.04; P = 0.045). The data from the current study support the prophylactic use of TA in patients undergoing repeat cardiac surgery. TA administered prior to CPB reduced the incidence of allogeneic transfusions and postoperative mediastinal tube drainage, and improved the subjective assessment of post-CPB hemostasis in a group of patients at moderately high risk for perioperative bleeding.
在体外循环（CPB）前给予氨甲环酸（TA）与心脏手术期间及术后出血减少有关。在一项前瞻性、随机、对照、双盲临床试验中，接受再次心脏直视手术的成年患者接受TA治疗（n = 17）或等量生理盐水安慰剂治疗（n = 13）。在TA组中，在胸骨切开时静脉注射（IV）初始剂量为20 mg/kg的TA，随后以2 mg·kg-1·h-1的速度输注，持续整个手术过程。两组遵循相同的输血指南。比较常规凝血试验、D-二聚体水平、纵隔引流管引流量和输血需求。TA组术后24小时测量的纵隔引流管累积引流量为649±391毫升（平均值±标准差），而安慰剂组为923±496毫升（P < 0.01）。TA组48小时和72小时的纵隔引流管引流量也显著减少（P < 0.01）。17例TA患者中有7例接受了异体血制品输血，而13例安慰剂患者中有1例接受了输血（P = 0.047）。与安慰剂组相比，TA组血小板和新鲜冰冻血浆的输血发生率和输血量无显著差异。安慰剂组围手术期D-二聚体水平的升高（CPB后减去CPB前）（中位数差异 = 675 ng/ml，范围125 - 1648）显著高于TA组（中位数差异 = 182 ng/ml，范围 - 426 - 1950；P = 0.003）。TA组胸骨闭合时间为41±21分钟，安慰剂组为61±49分钟（P = 0.14），TA组的主观出血评分低于安慰剂组（2.38±0.78对3.08±1.04；P = 0.045）。本研究数据支持在接受再次心脏手术的患者中预防性使用TA。在CPB前给予TA可降低异体输血的发生率和术后纵隔引流管引流量，并改善了一组围手术期出血风险中等偏高患者对CPB后止血的主观评估。
