中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2012年
11期
1320-1323
,共4页
王晖%徐诚实%岳云%吴安石
王暉%徐誠實%嶽雲%吳安石
왕휘%서성실%악운%오안석
巴曲酶%氨甲环酸%失血,手术%血液凝固试验
巴麯酶%氨甲環痠%失血,手術%血液凝固試驗
파곡매%안갑배산%실혈,수술%혈액응고시험
Batroxobin%Tranexamic acid%Blood loss,surgical%Blood coagulation tests
目的 探讨注射用血凝酶复合氨甲环酸对青少年特发性脊柱侧凸矫形术患者围术期出血及凝血功能的影响.方法 择期行青少年特发性脊柱侧凸矫形术患者80例,年龄15～ 26岁,体重41 ～ 56 kg,ASA分级Ⅰ级或Ⅱ级,采用随机数字表法,将患者随机分为4组(n=20):生理盐水组(A组):入室后静脉输注0.9％生理盐水；注射用血凝酶组(B组):切皮前20 min静脉注射用血凝酶0.02U/kg,每2h追加相同的剂量至术毕,最大剂量不超过1U;氨甲环酸组(C组):切皮即刻静脉注射氨甲环酸20 mg/kg,术中以10 mg·kg-1·h-1的速率静脉输注至术毕；注射用血凝酶复合氨甲环酸组(D组):按照B组和C组给药方法复合应用血凝酶及氨甲环酸.记录术中出血量、自体血回输量、异体输血量和新鲜冰冻血浆(FFP)用量、术后24 h内引流量.术前、术毕和术后1 d(T1～T3)时测定血常规和凝血功能[(凝血酶原时间(PT)、活化部分凝血活酶时间(ApTT)、纤维蛋白原(Fib)和凝血酶时间(TT),激活凝血时间(ACT)、形成血凝块速率(CR)及血小板功能(PF)]；术后1周采用血管超声检测深静脉血栓的发生情况.结果 与A组比较,B组、C组和D组术中出血量、异体血用量、FFP用量和自体血回输量和术后引流量降低,T2、T3时Plt、Fib升高,C组T2时PF升高,D组T2、T3时Hct、Plt、Fib和PF升高,PT延长(P＜0.05)；与B组比较,D组术中出血量、异体血用量、FFP用量、自体血回输量和术后引流量降低,T2、T3时Hct、Plt、Fib和PF升高,C组术后引流量增加,T2、T3时Plt升高(P＜0.05)；与C组比较,D组术中出血量、异体血输入量、自体血回输量、术后引流量和FFP用量减少,T2、T3时Hct、Plt、Fib和PF升高(P＜0.05).各组患者凝血功能均未见异常,术后均未发生深静脉血栓.结论 对于青少年特发性脊柱侧凸矫形术患者,氨甲环酸复合注射用凝血酶可有效减少术中出血量和异体血用量,改善凝血功能,优于两药单独应用的效果.
目的 探討註射用血凝酶複閤氨甲環痠對青少年特髮性脊柱側凸矯形術患者圍術期齣血及凝血功能的影響.方法 擇期行青少年特髮性脊柱側凸矯形術患者80例,年齡15～ 26歲,體重41 ～ 56 kg,ASA分級Ⅰ級或Ⅱ級,採用隨機數字錶法,將患者隨機分為4組(n=20):生理鹽水組(A組):入室後靜脈輸註0.9％生理鹽水；註射用血凝酶組(B組):切皮前20 min靜脈註射用血凝酶0.02U/kg,每2h追加相同的劑量至術畢,最大劑量不超過1U;氨甲環痠組(C組):切皮即刻靜脈註射氨甲環痠20 mg/kg,術中以10 mg·kg-1·h-1的速率靜脈輸註至術畢；註射用血凝酶複閤氨甲環痠組(D組):按照B組和C組給藥方法複閤應用血凝酶及氨甲環痠.記錄術中齣血量、自體血迴輸量、異體輸血量和新鮮冰凍血漿(FFP)用量、術後24 h內引流量.術前、術畢和術後1 d(T1～T3)時測定血常規和凝血功能[(凝血酶原時間(PT)、活化部分凝血活酶時間(ApTT)、纖維蛋白原(Fib)和凝血酶時間(TT),激活凝血時間(ACT)、形成血凝塊速率(CR)及血小闆功能(PF)]；術後1週採用血管超聲檢測深靜脈血栓的髮生情況.結果 與A組比較,B組、C組和D組術中齣血量、異體血用量、FFP用量和自體血迴輸量和術後引流量降低,T2、T3時Plt、Fib升高,C組T2時PF升高,D組T2、T3時Hct、Plt、Fib和PF升高,PT延長(P＜0.05)；與B組比較,D組術中齣血量、異體血用量、FFP用量、自體血迴輸量和術後引流量降低,T2、T3時Hct、Plt、Fib和PF升高,C組術後引流量增加,T2、T3時Plt升高(P＜0.05)；與C組比較,D組術中齣血量、異體血輸入量、自體血迴輸量、術後引流量和FFP用量減少,T2、T3時Hct、Plt、Fib和PF升高(P＜0.05).各組患者凝血功能均未見異常,術後均未髮生深靜脈血栓.結論 對于青少年特髮性脊柱側凸矯形術患者,氨甲環痠複閤註射用凝血酶可有效減少術中齣血量和異體血用量,改善凝血功能,優于兩藥單獨應用的效果.
목적 탐토주사용혈응매복합안갑배산대청소년특발성척주측철교형술환자위술기출혈급응혈공능적영향.방법 택기행청소년특발성척주측철교형술환자80례,년령15～ 26세,체중41 ～ 56 kg,ASA분급Ⅰ급혹Ⅱ급,채용수궤수자표법,장환자수궤분위4조(n=20):생리염수조(A조):입실후정맥수주0.9％생리염수；주사용혈응매조(B조):절피전20 min정맥주사용혈응매0.02U/kg,매2h추가상동적제량지술필,최대제량불초과1U;안갑배산조(C조):절피즉각정맥주사안갑배산20 mg/kg,술중이10 mg·kg-1·h-1적속솔정맥수주지술필；주사용혈응매복합안갑배산조(D조):안조B조화C조급약방법복합응용혈응매급안갑배산.기록술중출혈량、자체혈회수량、이체수혈량화신선빙동혈장(FFP)용량、술후24 h내인류량.술전、술필화술후1 d(T1～T3)시측정혈상규화응혈공능[(응혈매원시간(PT)、활화부분응혈활매시간(ApTT)、섬유단백원(Fib)화응혈매시간(TT),격활응혈시간(ACT)、형성혈응괴속솔(CR)급혈소판공능(PF)]；술후1주채용혈관초성검측심정맥혈전적발생정황.결과 여A조비교,B조、C조화D조술중출혈량、이체혈용량、FFP용량화자체혈회수량화술후인류량강저,T2、T3시Plt、Fib승고,C조T2시PF승고,D조T2、T3시Hct、Plt、Fib화PF승고,PT연장(P＜0.05)；여B조비교,D조술중출혈량、이체혈용량、FFP용량、자체혈회수량화술후인류량강저,T2、T3시Hct、Plt、Fib화PF승고,C조술후인류량증가,T2、T3시Plt승고(P＜0.05)；여C조비교,D조술중출혈량、이체혈수입량、자체혈회수량、술후인류량화FFP용량감소,T2、T3시Hct、Plt、Fib화PF승고(P＜0.05).각조환자응혈공능균미견이상,술후균미발생심정맥혈전.결론 대우청소년특발성척주측철교형술환자,안갑배산복합주사용응혈매가유효감소술중출혈량화이체혈용량,개선응혈공능,우우량약단독응용적효과.
Objective To investigate the effect of batroxobin combined with tranexamic acid on the perioperative bleeding and blood coagulation in the patients undergoing adolescent idiopathic scoliosis.Methods Eighty ASA Ⅰ or Ⅱ patients,aged 15-26 yr,weighing 41-56 kg,scheduled for elective adolescent idiopathic scoliosis,were randomly divided into 4 groups (n =20 each):normal saline group (group A),batroxobin group (group B),tranexamic acid group (group C) and batroxobin combined with tranexamic acid group (group D).0.9 ％ normal saline was infused after admission to the operating room in group A.Batroxobin 0.02 U/kg was infused at 20 min before skin incision,an increment of 0.02 U/kg was given every 2 h until the end of operation and the maximal dose was less than 1 U in group B.Tranexamic acid 20 mg/kg was injected immediately before skin incision,followed by infusion at 10 mg· kg-1 · h-1 until the end of operation in group C.In group D,batroxobin and tranexamic acid were given as the method described in B and C groups.The intraoperative blood loss,volume of autologous and allogeneic blood transfused,transfusion of fresh frozen plasma (FFP),and volume of drainage within 24 h after operation were recorded.Blood routine,prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (Fbi),thrombin time (TT),activated clotting time (ACT),clot rate (CR) and platelet function (PF) were measured.Deep vein thrombosis was detected at 1 week after operation.Results Compared with group A,the intraoperative blood loss,volume of allogeneic blood transfused,transfusion of FFP,volume of autologous blood transfused and volume of postoperative drainage were significantly reduced,and Plt and Fib were significantly increased at T2,3 in groups B,C and D,and PF was increased at T2 in group C,Hct,Plt,Fib and PF were increased and PT was prolonged at T2,3 in group D (P ＜ 0.05).Compared with group B,the intraoperative blood loss,volume of allogeneic blood transfused,transfusion of FFP,volume of autologous blood transfused and volume of postoperative drainage were significantly decreased and Hct,Plt,Fib and PF were increased at T2,3 in group D,and the volume of postoperative drainage was increased and Plt increased at T2,3 was in group C (P ＜ 0.05).Compared with group C,the intraoperative blood loss,volume of allogeneic blood transfused,volume of autologous blood transfused,volume of postoperative drainage and transfusion of FFP were significantly decreased and Hct,Plt,Fib and PF were significantly increased at T2,3 in group D (P ＜ 0.05).No patients developed blood coagulation disorder and deep vein thrombosis.Conclusion Batroxobin combined with tranexamic acid can significantly reduce the intraoperative blood loss and volume of allogeneic blood transfused and improve the blood coagulation,and the efficacy is superior to that of either alone for the patients undergoing adolescent idiopathic scoliosis.
