氨甲环酸可减少心脏再次手术中的失血和输血。

Tranexamic acid reduces blood loss and transfusion in reoperative cardiac surgery.

作者信息

Dryden P J, O'Connor J P, Jamieson W R, Reid I, Ansley D, Sadeghi H, Burr L H, Munro A I, Merrick P M

机构信息

Department of Anaesthesia, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Vancouver, Canada.

出版信息

Can J Anaesth. 1997 Sep;44(9):934-41. doi: 10.1007/BF03011964.

DOI:10.1007/BF03011964

PMID:9305556

Abstract

PURPOSE

The objective of this study was to assess the effect of tranexamic acid (TA), a synthetic antifibrinolytic, on blood loss and the need for transfusion of blood products following repeat cardiac valve surgery.

METHODS

After ethics committee approval, 41 patients scheduled for reoperative valve replacement were enrolled in this randomized, double blind, placebo controlled study. Patients were randomized to receive TA (10 g in 500 ml NSaline) or placebo (NSaline) as an iv bolus over 30 min, after anaesthesia induction and prior to skin incision. Intraoperative blood loss was assessed by estimating blood volume on drapes, weighing surgical sponges, and measuring suction bottle returns. Postoperative blood loss was measured from mediastinal chest tube drainage following surgery. Blood products were transfused according to a standardized protocol.

RESULTS

Patient demographics were similar for age, sex, cardiopulmonary bypass pump time, cross clamp time, surgical time, preoperative haemoglobin, coagulation profile, and the number of valves replaced during surgery. Tranexamic acid administration reduced intraoperative blood loss [median (range)] from 1656 (575-6270) to 720 ml (355-5616) (P < 0.01) and postoperative blood loss from 1170 (180-4025) to 538 ml (135-1465) (Intent to Treat n = 41, P < 0.01). The total red blood cells transfused (median, range) was reduced from 1500 (0-9300) ml to 480 (0-2850) ml (P < 0.01) in the TA group. In hospital complications and mortality rates were not reduced in the TA group.

CONCLUSION

Tranexamic acid reduced blood loss and the need for blood product transfusion and appears to be an effective treatment for patients undergoing reoperative cardiac valvular surgery.

摘要

目的

本研究的目的是评估合成抗纤溶药物氨甲环酸（TA）对再次心脏瓣膜手术后失血及输血需求的影响。

方法

经伦理委员会批准后，41例计划再次进行瓣膜置换手术的患者被纳入这项随机、双盲、安慰剂对照研究。患者在麻醉诱导后、皮肤切开前被随机分配接受TA（10 g溶于500 ml生理盐水中）或安慰剂（生理盐水）静脉推注30分钟。术中失血量通过估计手术单上的血量、称量手术海绵重量以及测量吸引瓶回血来评估。术后失血量通过手术后纵隔胸管引流来测量。血液制品根据标准化方案进行输注。

结果

患者在年龄、性别、体外循环泵时间、主动脉阻断时间、手术时间、术前血红蛋白、凝血指标以及手术中置换瓣膜数量等人口统计学特征方面相似。氨甲环酸的使用使术中失血量[中位数（范围）]从1656（575 - 6270）ml降至720 ml（355 - 5616）ml（P < 0.01），术后失血量从1170（180 - 4025）ml降至538 ml（135 - 1465）ml（意向性分析n = 41，P < 0.01）。TA组输注的总红细胞量（中位数，范围）从1500（0 - 9300）ml降至480（0 - 2850）ml（P < 0.01）。TA组的院内并发症和死亡率并未降低。