目的:观察氨甲环酸对心脏手术后出血量的影响。方法:根据临床停止使用抑肽酶的时间,将560例行心脏手术患者分为抑肽酶组(n=303)和氨甲环酸组(n=257),对两组术后失血量、二次开胸止血率、输血量、急性肾功能不全及低心排综合征发生率等进行比较。结果:术后24 h出血量氨甲环酸组为(578.5±386.0) ml,抑肽酶组为(629.3±366.7) ml,两组差异无统计学意义(P=0.111)。二次开胸止血率氨甲环酸组为3.9%,抑肽酶组为4.3%,两组差异无统计学意义(P=0.730)。术后红细胞需求量氨甲环酸组为(2.39±6.20) U,抑肽酶组为(2.08±4.92) U;血浆需求量氨甲环酸组为(1.58±4.85)100 ml,抑肽酶组为(1.67±4.88)100 ml;血小板需求量氨甲环酸组为(1.19±5.12)10 U,抑肽酶组为(1.51±5.29)10 U,两组差异均无统计学意义(分别P=0.149、0.355、0.797)。结论:心脏手术中应用氨甲环酸可有效减少术后出血量及血制品需求量,其效果与抑肽酶相似。 |
Objective: To investigate the influence of using tranexamic acid during cardiac surgery on reduce postoperative bleeding. Methods: A total of 560 cases were involved, of which 303 in aprotinin group and 257 in tranexamic acid group. Postoperative blood loss, rate of reoperation for excessive postoperative bleeding, transfusion requirements, rate of acute renal failure and low cardiac output syndrome were compared between the two groups. Results: There were no significance differences of postoperative blood loss and rate of reoperation for excessive postopearative bleeding(3.9% vs 4.3%, P=0.730) between two groupes. The requirements of red blood cell, plasma, platelets were(2.39±3.20) U, (1.58±4.85)100 ml, (1.19±5.12)10 U in tranexamic acid groupe while(2.08±4.92) U, (1.67±4.88)100 ml、 (1.51±5.29)10 U in aprotinin groupe, also showing no significance differences(P=0.149, 0.355, 0.797). Conclusions: Tranexamic acid is as effective as aprotinin to reduce postoperative bleeding, transfusion requirements during cardiac operation. |
[1] ICKX B E,LINDEN P J,MELOT C,et al.Comparison of the effects of aprotinin and tranexamic acid on blood loss and red blood cell transfusion requirements during the late stages of liver transplantation[J].Transfusion,2006,46(4):595-605.
[2] VAMVAKAS E C.Pneumonia as a complication of blood product transfusion in the critically ill:transfusion-related immunomodulation(TRIM)[J].Crit Care Med,2006,34(5 Suppl):S151-159.
[3] SCHOUTEN E S,van de POL A C,SCHOUTEN A N,et al.The effect of aprotinin,tranexamic acid,and aminocaproic acid on blood loss and use of blood products in major pediatric surgery:a meta-analysis[J].Pediatr Crit Care Med,2009,10(2):182-190.
[4] MANGANO D T,TUDOR I C,DIETZEL C,et al.The risk associated with aprotinin in cardiac surgery[J].N Engl J Med,2006,354:353-365.
[5] MANGANO D T,MIAO Y,VUYLSTEKE A,et al.Mortality associated with aprotinin during 5 years following coronary artery bypass graft surgery[J].JAMA,2007,297(5):471-479.
[6] FERGUSSON D A,HEBERT P C,MAZER C D,et al.A comparison of aprotinin and lysine analogues in high-risk cardiac surgery[J].N Engl J Med,2008,358:2319-2331.
[7] KUITUNEN A,HIIPPALA S,VAHTERA E,et al.The effects of aprotinin and tranexamic acid on thrombin generation and fibrinolytic response after cardiac surgery[J].Acta Anaesthesiol Scand,2005,49(9):1272-1279.
[8] YASIM A,ASIK R,ATAHAN E.Effects of topical applications of aprotinin and tranexamic acid on blood loss after open heart surgery[J].Anadolu Kardiyol Derg,2005,5(1):36-40.
[9] KARKOUTI K,BEATTIE W S,DATTILO K M,et al.A propensity score case-control comparison of aprotinin and tranexamic acid in high-transfusion-risk cardiac surgery[J].Transfusion,2006,46(3):327-338.
[10] AIT H M,SELKANE C,AMAHZOUNE B,et al. Antifibrinolytic agents and repeat open-heart surgery:a comparison of tranexamic acid and low dose aprotinin[J].Ann Cardiol Angeiol(Paris),2007,56(6):308-312.
[11] NUTTALL G A,GUTIERREZ M C,DEWEY J D,et al.A preliminary study of a new tranexamic acid dosing schedule for cardiac surgery[J].J Cardiothorac Vasc Anesth,2008,22(2):230-235.
[12] ARMELLIN G,VINCIGUERRA A,BONATO R,et al.Tranexamic acid in primary CABG surgery:high vs low dose[J].Minerva Anestesiol,2004,70(3):97-107.
[13] TAKAGI H,MANABE H,KAWAI N,et al.Aprotinin increases mortality as compared with tranexamic acid in cardiac surgery:a meta-analysis of randomized head-to-head trials[J].Interact Cardiovasc Thorac Surg,2009,9(1):98-101.
[14] BROWN J R.Mortality manifesto:a meta-analysis of aprotinin and tranexamic acid mortality[J].Eur J Cardiothorac Surg,2009,36(4):781-782.
[15] STAMOU S C,REAMES M K,SKIPPER E,et al.Aprotinin in cardiac surgery patients:is the risk worth the benefit[J].Eur J Cardiothorac Surg,2009,36(5):869-875.
[16] 李鸿雁,刘志勇,吴熹.联合应用小剂量抑肽酶与大剂量氨甲苯酸减少体外循环术后出血的研究[J].现代医学,2002,30(4):221-223. |