中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2011年
1期
7-9
,共3页
王古岩%石佳%杨静%王海玲%史春霞%林霖%王剑辉%王越夫%于钦军%李立环
王古巖%石佳%楊靜%王海玲%史春霞%林霖%王劍輝%王越伕%于欽軍%李立環
왕고암%석가%양정%왕해령%사춘하%림림%왕검휘%왕월부%우흠군%리립배
氨甲环酸%冠状动脉旁路移植术,非体外循环%手术后出血%输血
氨甲環痠%冠狀動脈徬路移植術,非體外循環%手術後齣血%輸血
안갑배산%관상동맥방로이식술,비체외순배%수술후출혈%수혈
Tranexamic acid%Coronary artery bypass,off-pump%Postoperative hemorrhage%Blood transfusion
目的 评价氨甲环酸对非体外循环冠状动脉旁路移植术病人的血液保护作用.方法 择期行非体外循环冠状动脉旁路移植术的病人260例,性别不限,年龄18～64岁,体重指数16～22 kg/m2,ASA分级Ⅰ～Ⅲ级,NYHA分级Ⅰ～Ⅲ级.采用随机数字表法,将病人随机分为2组(n=130):对照组(C组)和氨甲环酸组(T组).麻醉诱导后T组经30 min静脉输注氨甲环酸1 g,然后以400 mg/h的速率持续输注至术毕;C组给予等容量生理盐水.分别于麻醉诱导前、术毕和术后24 h时,取中心静脉血样,测定Hb、Plt、凝血酶原时间和国际标准化比值.于术后6和24 h时记录胸管引流量.记录术后异体红细胞和血浆的使用情况.记录住院期间死亡和并发症的发生情况.结果 两组各时点Hb、Plt、凝血酶原时间和国际标准化比值比较差异无统计学意义(P＞0.05).与C组比较,T组术后胸管引流量、异体红细胞和血浆的使用率均降低(P＜0.05或0.01).两组未见住院期间死亡和术后并发症的发生.结论 氨甲环酸对非体外循环冠状动脉旁路移植术病人具有血液保护作用.
目的 評價氨甲環痠對非體外循環冠狀動脈徬路移植術病人的血液保護作用.方法 擇期行非體外循環冠狀動脈徬路移植術的病人260例,性彆不限,年齡18～64歲,體重指數16～22 kg/m2,ASA分級Ⅰ～Ⅲ級,NYHA分級Ⅰ～Ⅲ級.採用隨機數字錶法,將病人隨機分為2組(n=130):對照組(C組)和氨甲環痠組(T組).痳醉誘導後T組經30 min靜脈輸註氨甲環痠1 g,然後以400 mg/h的速率持續輸註至術畢;C組給予等容量生理鹽水.分彆于痳醉誘導前、術畢和術後24 h時,取中心靜脈血樣,測定Hb、Plt、凝血酶原時間和國際標準化比值.于術後6和24 h時記錄胸管引流量.記錄術後異體紅細胞和血漿的使用情況.記錄住院期間死亡和併髮癥的髮生情況.結果 兩組各時點Hb、Plt、凝血酶原時間和國際標準化比值比較差異無統計學意義(P＞0.05).與C組比較,T組術後胸管引流量、異體紅細胞和血漿的使用率均降低(P＜0.05或0.01).兩組未見住院期間死亡和術後併髮癥的髮生.結論 氨甲環痠對非體外循環冠狀動脈徬路移植術病人具有血液保護作用.
목적 평개안갑배산대비체외순배관상동맥방로이식술병인적혈액보호작용.방법 택기행비체외순배관상동맥방로이식술적병인260례,성별불한,년령18～64세,체중지수16～22 kg/m2,ASA분급Ⅰ～Ⅲ급,NYHA분급Ⅰ～Ⅲ급.채용수궤수자표법,장병인수궤분위2조(n=130):대조조(C조)화안갑배산조(T조).마취유도후T조경30 min정맥수주안갑배산1 g,연후이400 mg/h적속솔지속수주지술필;C조급여등용량생리염수.분별우마취유도전、술필화술후24 h시,취중심정맥혈양,측정Hb、Plt、응혈매원시간화국제표준화비치.우술후6화24 h시기록흉관인류량.기록술후이체홍세포화혈장적사용정황.기록주원기간사망화병발증적발생정황.결과 량조각시점Hb、Plt、응혈매원시간화국제표준화비치비교차이무통계학의의(P＞0.05).여C조비교,T조술후흉관인류량、이체홍세포화혈장적사용솔균강저(P＜0.05혹0.01).량조미견주원기간사망화술후병발증적발생.결론 안갑배산대비체외순배관상동맥방로이식술병인구유혈액보호작용.
Objective To investigate the blood-saving effect of tranexamic acid in off-pump coronary artery bypass (OPCAB). Methods Two hundred and sixty ASA Ⅰ- Ⅲ and NYHA Ⅰ- Ⅲ patients of both sexes,aged 18-64 yr, with body mass index 16-22 kg/m2 , undergoing OPCAB, were randomly divided into 2 groups (n = 130 each): control group (group C) and tranexamic acid group (group T) . Anesthesia was induced with iv injection of midazolam 0.1 mg/kg, fentanyl 5-10μg/kg and pipecuronium 0.1 mg/kg. The patients were tracheal intubated and mechanically ventilated. PEr CO2 was maintained at 35-45 mm Hg. A bolus of tranexamic acid 1 g was infused intravenously within 30 min after indution followed by continuous infusion at 400 mg/h until the end of operation in group T. While equal volume of normal saline was given in control group. Anesthesia was maintained with inhalation of isoflurane and intermittent iv injection of fentanyl and pipecuronium. Venous blood samples were taken before induction, at the end of operation and at 24 h after operation for determination of Hb, platelet count (P1t), prothrombin time (PT) and international normalized ratio (INR). The volume of chest tube drainage was collected and recorded at 6 and 24 h after operation. The requirement for transfusion of allogeneic red blood cells and fresh frozen plasma was also recorded. Results There was no significant difference in Hb, Plt, PTand INR at each time point between the two groups ( P ＞ 0.05). The requirement for transfusion of allogeneic red blood cells and fresh frozen plasma was significantly reduced in group T as compared with group C ( P ＜ 0.05 or 0.01 ). No deaths and complications occurred during hospital stay in the two groups. Conclusion Tranexamic acid exerts the blood-saving effect in OPCAB.
