中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2012年
1期
15-19
,共5页
氨甲环酸%胰蛋白酶抑制剂%输注,静脉内%纤维蛋白溶解%肝移植
氨甲環痠%胰蛋白酶抑製劑%輸註,靜脈內%纖維蛋白溶解%肝移植
안갑배산%이단백매억제제%수주,정맥내%섬유단백용해%간이식
Tranexamic acid%Trypsin inhibitors%Infusions,intravenous%Fibrinolysis%Liver transplantation
目的 评价静脉输注中等剂量氨甲环酸和乌司他丁对原位肝移植术患者纤溶功能的影响.方法 拟行原位肝移植术患者30例,性别不限,年龄34 ～ 63岁,体重指数17 ～ 37 kg/m2,终末期肝病模型评分6～34分,ASA分级Ⅲ或Ⅳ级.采用随机数字表法,将患者随机分为3组(n=10):对照组(C组)、氨甲环酸组(T组)和乌司他丁组(U组).U组和C组气管插管后分别静脉输注乌司他丁100 000 U/h或生理盐水10 ml/h直至新肝期120 min;T组气管插管后静脉注射氨甲环酸负荷量1 g,随后以10 mg·kg-1 ·h-1速率静脉输注至新肝期120 min.分别于麻醉诱导前(T0)、无肝前期120 min(T1)、无肝期30 min(T2)、新肝期30 min(T3)、新肝期120 min(T4)和术毕(T5)时采集静脉血样,测定凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、国际标准化比值(INR)、纤维蛋白原(Fg)、D-二聚体(D-D)和纤维蛋白降解产物(FDP)的水平.记录术中出血量及输血情况.记录术后14 d内T组和U组肝动脉或门静脉血栓形成情况.结果 3组间血浆PT、APTT、Fg、INR、出血量和输血量差异无统计学意义(P＞0.05).与C组比较,T组T3-5时血浆D-D浓度降低,T4.5时血浆FDP＞ 20 μg/ml比率降低(P＜ 0.05或0.01),U组血浆D-D浓度和血浆FDP＞ 20μg/ml比率差异无统计学意义(P＞0.05).T组和U组未见肝动脉或门静脉血栓形成.结论 术中静脉输注中等剂量氨甲环酸可抑制原位肝移植术患者纤溶功能,但不足以减少出血量；术中静脉输注乌司他丁100 000 U/h对原位肝移植术患者纤溶功能无影响.
目的 評價靜脈輸註中等劑量氨甲環痠和烏司他丁對原位肝移植術患者纖溶功能的影響.方法 擬行原位肝移植術患者30例,性彆不限,年齡34 ～ 63歲,體重指數17 ～ 37 kg/m2,終末期肝病模型評分6～34分,ASA分級Ⅲ或Ⅳ級.採用隨機數字錶法,將患者隨機分為3組(n=10):對照組(C組)、氨甲環痠組(T組)和烏司他丁組(U組).U組和C組氣管插管後分彆靜脈輸註烏司他丁100 000 U/h或生理鹽水10 ml/h直至新肝期120 min;T組氣管插管後靜脈註射氨甲環痠負荷量1 g,隨後以10 mg·kg-1 ·h-1速率靜脈輸註至新肝期120 min.分彆于痳醉誘導前(T0)、無肝前期120 min(T1)、無肝期30 min(T2)、新肝期30 min(T3)、新肝期120 min(T4)和術畢(T5)時採集靜脈血樣,測定凝血酶原時間(PT)、活化部分凝血酶原時間(APTT)、國際標準化比值(INR)、纖維蛋白原(Fg)、D-二聚體(D-D)和纖維蛋白降解產物(FDP)的水平.記錄術中齣血量及輸血情況.記錄術後14 d內T組和U組肝動脈或門靜脈血栓形成情況.結果 3組間血漿PT、APTT、Fg、INR、齣血量和輸血量差異無統計學意義(P＞0.05).與C組比較,T組T3-5時血漿D-D濃度降低,T4.5時血漿FDP＞ 20 μg/ml比率降低(P＜ 0.05或0.01),U組血漿D-D濃度和血漿FDP＞ 20μg/ml比率差異無統計學意義(P＞0.05).T組和U組未見肝動脈或門靜脈血栓形成.結論 術中靜脈輸註中等劑量氨甲環痠可抑製原位肝移植術患者纖溶功能,但不足以減少齣血量；術中靜脈輸註烏司他丁100 000 U/h對原位肝移植術患者纖溶功能無影響.
목적 평개정맥수주중등제량안갑배산화오사타정대원위간이식술환자섬용공능적영향.방법 의행원위간이식술환자30례,성별불한,년령34 ～ 63세,체중지수17 ～ 37 kg/m2,종말기간병모형평분6～34분,ASA분급Ⅲ혹Ⅳ급.채용수궤수자표법,장환자수궤분위3조(n=10):대조조(C조)、안갑배산조(T조)화오사타정조(U조).U조화C조기관삽관후분별정맥수주오사타정100 000 U/h혹생리염수10 ml/h직지신간기120 min;T조기관삽관후정맥주사안갑배산부하량1 g,수후이10 mg·kg-1 ·h-1속솔정맥수주지신간기120 min.분별우마취유도전(T0)、무간전기120 min(T1)、무간기30 min(T2)、신간기30 min(T3)、신간기120 min(T4)화술필(T5)시채집정맥혈양,측정응혈매원시간(PT)、활화부분응혈매원시간(APTT)、국제표준화비치(INR)、섬유단백원(Fg)、D-이취체(D-D)화섬유단백강해산물(FDP)적수평.기록술중출혈량급수혈정황.기록술후14 d내T조화U조간동맥혹문정맥혈전형성정황.결과 3조간혈장PT、APTT、Fg、INR、출혈량화수혈량차이무통계학의의(P＞0.05).여C조비교,T조T3-5시혈장D-D농도강저,T4.5시혈장FDP＞ 20 μg/ml비솔강저(P＜ 0.05혹0.01),U조혈장D-D농도화혈장FDP＞ 20μg/ml비솔차이무통계학의의(P＞0.05).T조화U조미견간동맥혹문정맥혈전형성.결론 술중정맥수주중등제량안갑배산가억제원위간이식술환자섬용공능,단불족이감소출혈량；술중정맥수주오사타정100 000 U/h대원위간이식술환자섬용공능무영향.
Objective To investigate the effects of continuous infusion of moderate dose tranexamic acid and ulinastatin on fibrinolysis during orthotopic liver transplantation (OLT).Methods Thirty ASA Ⅲ or Ⅳ patients aged 34-63 yr with a body mass index of 17-37 kg/m2 and end-stage liver disease score 6-34,undergoing OLT,were randomly assigned to one of 3 groups ( n =10 each):group control (group C) ; group tranexamic acid (group T) and group ulinastatin (group U).The patients received continuous infusion of normal saline at 10 ml/h in group C or ulinastatin at 100 000 U/h in group U immediately after tracheal intubation until 120 min after portal vein was declamped,while in group T the patients received a loading dose of tranexamic acid 1 g followed by continuous infusion at 10 mg· kg-1 ·h- 1.Prothrombin time (PT),activated partial thromboplastin time (APTT),international normalized ratio ( INR),fibrinogen (Fg),D-dimers (D-D) and fibrin degradation product (FDP) were measured before induction of anesthesia (baseline),at 120 min after skin incision,30 min after clamping of portal vein (anhepatic phase),30 and 120 min after declamping (neohepatic phase) and at the end of operation.The amount of blood loss and transfusion were recorded.The patients were followed up after operation for hepatic artery and portal vein thrombosis in groups U and T.Results There were no significant differences in PT,APTT,Fg,INR and amount of blood loss and transfusion among the 3 groups.The plasma D-D concentration and percentage of patients with plasma FDP ＞ 20μg/ml were significantly lower in group T than in group C.There were no significant differences in plasma D-D concentration and percentage of patients with plasma FDP ＞ 20 μg/ml between groups U and C.No hepatic artery and portal vein thrombosis was detected after operation in groups T and U.Conclusion Continuous infusion of moderate dose tranexamic acid can inhibit fibrinolysis during OLT,but can not reduce the amount of blood loss.Continuous infusion of ulinastatin ( 100 000 U/h) has no significant effect on fibrinolysis during OLT.
