CAJ | 학술논문

目的评价注射用血凝酶复合氨甲环酸用于非体外循环冠状动脉旁路移植术(OPCABG)患者的血液保护作用.方法择期拟行OPCABG患者80例,年龄50～ 70岁,性别不限,体重50 ～ 100 kg,ASA分级Ⅱ级,心功能NYHA分级Ⅰ或Ⅱ级.采用随机数字表法,将患者随机分为4组(n=20):对照组(C组)、注射用血凝酶组(H组)、氨甲环酸组(T组)和注射用血凝酶复合氨甲环酸组(HT组).H组切皮前20 min静脉滴注注射用血凝酶0.04 U/kg(最高剂量4U),静脉注射鱼精蛋白后15 min时追加2U,然后每隔2h追加2U至术毕；T组切皮时静脉滴注氨甲环酸20 mg/kg,以10mg· kg-1·h-1的速率输注至术毕；HT组按上述两组的给药方法复合用药.记录术中出血量,异体红细胞和血浆使用情况,术后0～6和6～24 h引流量,总引流量和输血量.记录术后深静脉血栓形成的发生情况.结果与C组比较,T组和HT组术中出血等级降低,T组、H组和HT组异体红细胞输入量、血浆输入量,术后0～6、6～24 h引流量和总引流量降低(P＜0.05)；与H组和T组比较,HT组异体红细胞输入量、血浆输入量,术后0～6、6～24 h引流量和总引流量均降低(P＜0.05).四组均未见深静脉血栓形成的发生.结论注射用血凝酶复合氨甲环酸用于OPCABG患者的血液保护作用优于单独应用,且不增加血栓形成的风险.
목적 평개주사용혈응매복합안갑배산용우비체외순배관상동맥방로이식술(OPCABG)환자적혈액보호작용.방법 택기의행OPCABG환자80례,년령50～ 70세,성별불한,체중50 ～ 100 kg,ASA분급Ⅱ급,심공능NYHA분급Ⅰ혹Ⅱ급.채용수궤수자표법,장환자수궤분위4조(n=20):대조조(C조)、주사용혈응매조(H조)、안갑배산조(T조)화주사용혈응매복합안갑배산조(HT조).H조절피전20 min정맥적주주사용혈응매0.04 U/kg(최고제량4U),정맥주사어정단백후15 min시추가2U,연후매격2h추가2U지술필；T조절피시정맥적주안갑배산20 mg/kg,이10mg· kg-1·h-1적속솔수주지술필；HT조안상술량조적급약방법복합용약.기록술중출혈량,이체홍세포화혈장사용정황,술후0～6화6～24 h인류량,총인류량화수혈량.기록술후심정맥혈전형성적발생정황.결과 여C조비교,T조화HT조술중출혈등급강저,T조、H조화HT조이체홍세포수입량、혈장수입량,술후0～6、6～24 h인류량화총인류량강저(P＜0.05)；여H조화T조비교,HT조이체홍세포수입량、혈장수입량,술후0～6、6～24 h인류량화총인류량균강저(P＜0.05).사조균미견심정맥혈전형성적발생.결론 주사용혈응매복합안갑배산용우OPCABG환자적혈액보호작용우우단독응용,차불증가혈전형성적풍험.
Objective To evaluate the blood-saving effect of combination of hemocoagulase artox for injection and tranexamic acid (TXA) in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods Eighty ASA Ⅱ patients (NYHA Ⅰ or Ⅱ),aged 50-70 yr,weighing 50-100 kg,scheduled for elective OPCABG,were randomly divided into 4 groups (n =20 each):control group (group C),hemocoagulase atrox for injection group (group H,n =20),TXA group (group T) and hemocoagulase atrox for injection + ·TXA group (group HT).Hemocoagulase atrox 0.04 U/kg (the highest dose 4 U) was injected at 20 min before skin incision,and additional hemocoagulase atrox 2 U was given every 2 h starting from 15 min after administration of protamine until the end of operation in group H.TXA 20 mg/kg was injected intravenously at skin incision,followed by a continuous infusion of TXA at 10 mg· kg-1 · h-1 until the end of operation in group T.Hemocoagulase atrox and TXA were given as the method described in groups H and T.Venous blood samples were taken from the central vein before operation,at the end of operation,and 24 h after operation to determine the plasma D-Dimer concentration.The amount of blood loss,allogeneic red blood cells and plasma infused during operation,volume of drainage during 0-6 and 6-24 h after operation,total volume of drainage and volume of allogeneic blood transfused during operation were recorded.The deep vein thrombosis was recorded.Results Compared with group C,the amount of blood loss during operation was significantly decreased in groups T and HT,and the allogeneic red blood cells and plasma infused during operation,and volume of drainage during 0-6 and 6-24 h after operation,and total volume of drainage were significantly decreased in groups H,T and HT (P ＜ 0.05).Compared with groups H and T,the allogeneic red blood cells and plasma infused during operation,and volume of drainage during 0-6 and 6-24 h after operation,and total volume of drainage were significantly decreased in group HT (P ＜ 0.05).No deep vein thrombosis was observed in the 4 groups.Conclusion The combination of hemocoagulase artox for injection and TXA provides better blood-saving effect than either alone for the patients undergoing OPCABG without increasing the risk for thrombosis.