中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
Chinese Journal of Anesthesiology
2015年
6期
677-679
,共3页
夏莉%袁峰%杨鹏举%董铁立
夏莉%袁峰%楊鵬舉%董鐵立
하리%원봉%양붕거%동철립
氨甲环酸%法洛四联症%心肺转流术%儿童
氨甲環痠%法洛四聯癥%心肺轉流術%兒童
안갑배산%법락사련증%심폐전류술%인동
Tranexamic acid%Tetralogy of Fallot%Cardiopulmonary bypass%Child
目的 评价氨甲环酸对体外循环(CPB)法洛四联症矫正术患儿的血液保护效应.方法 择期行CPB法洛四联症矫正术患儿56例,性别不限,年龄11个月～14岁,BMI 9.8～21.4 kg/m2,ASA分级为Ⅱ或Ⅲ级,左室射血分数＞50％,采用随机数字表法分为2组:氨甲环酸组(TA组,n=30)和生理盐水对照组(NS组,n=26).TA组切皮前经20 min静脉输注氨甲环酸负荷量10 mg/kg,继以10 mg·kg-1·h-1速率维持至术毕,NS组按照同样方法给予等容量生理盐水.记录术后24 h引流量、红细胞、新鲜冰冻血浆、血小板和冷沉淀的输入量,记录二次开胸止血情况和TA组术后1周门静脉及肝动脉血栓的发生情况.结果 与NS组比较,TA组术后24 h引流量、红细胞、新鲜冰冻血浆、血小板及冷沉淀输入量减少(P＜0.05).TA组无二次开胸止血,NS组二次开胸止率血15％.TA组均未见门静脉及肝动脉血栓.结论 氨甲环酸(负荷量10 mg/kg,维持量10 mg·kg-1·h-1)对CPB法洛四联症矫正术患儿具有血液保护效应,且安全性较高.
目的 評價氨甲環痠對體外循環(CPB)法洛四聯癥矯正術患兒的血液保護效應.方法 擇期行CPB法洛四聯癥矯正術患兒56例,性彆不限,年齡11箇月～14歲,BMI 9.8～21.4 kg/m2,ASA分級為Ⅱ或Ⅲ級,左室射血分數＞50％,採用隨機數字錶法分為2組:氨甲環痠組(TA組,n=30)和生理鹽水對照組(NS組,n=26).TA組切皮前經20 min靜脈輸註氨甲環痠負荷量10 mg/kg,繼以10 mg·kg-1·h-1速率維持至術畢,NS組按照同樣方法給予等容量生理鹽水.記錄術後24 h引流量、紅細胞、新鮮冰凍血漿、血小闆和冷沉澱的輸入量,記錄二次開胸止血情況和TA組術後1週門靜脈及肝動脈血栓的髮生情況.結果 與NS組比較,TA組術後24 h引流量、紅細胞、新鮮冰凍血漿、血小闆及冷沉澱輸入量減少(P＜0.05).TA組無二次開胸止血,NS組二次開胸止率血15％.TA組均未見門靜脈及肝動脈血栓.結論 氨甲環痠(負荷量10 mg/kg,維持量10 mg·kg-1·h-1)對CPB法洛四聯癥矯正術患兒具有血液保護效應,且安全性較高.
목적 평개안갑배산대체외순배(CPB)법락사련증교정술환인적혈액보호효응.방법 택기행CPB법락사련증교정술환인56례,성별불한,년령11개월～14세,BMI 9.8～21.4 kg/m2,ASA분급위Ⅱ혹Ⅲ급,좌실사혈분수＞50％,채용수궤수자표법분위2조:안갑배산조(TA조,n=30)화생리염수대조조(NS조,n=26).TA조절피전경20 min정맥수주안갑배산부하량10 mg/kg,계이10 mg·kg-1·h-1속솔유지지술필,NS조안조동양방법급여등용량생리염수.기록술후24 h인류량、홍세포、신선빙동혈장、혈소판화랭침정적수입량,기록이차개흉지혈정황화TA조술후1주문정맥급간동맥혈전적발생정황.결과 여NS조비교,TA조술후24 h인류량、홍세포、신선빙동혈장、혈소판급랭침정수입량감소(P＜0.05).TA조무이차개흉지혈,NS조이차개흉지솔혈15％.TA조균미견문정맥급간동맥혈전.결론 안갑배산(부하량10 mg/kg,유지량10 mg·kg-1·h-1)대CPB법락사련증교정술환인구유혈액보호효응,차안전성교고.
Objective To evaluate the blood-saving effect of tranexamic acid in pediatric patients undergoing radical correction of tetralogy of Fallot with cardiopulmonary bypass (CPB).Methods A total of 56 children of both sexes,aged 11 months-14 yr,with body mass index of 9.8-21.4 kg/m2,of ASA physical status Ⅱ or Ⅲ,with left ventricular ejection fraction ＞50％,scheduled for elective radical correction of tetralogy of Fallot with CPB,were randomly divided into 2 groups using a random number table:tranexamic acid group (TA group,n =30) and normal saline group (NS group,n =26).Anesthesia was induced with iv midazolam,sufentanil,vecuronium and propofol.The children were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with inhalation of 1％-2％ sevoflurane and infusion of propofol,sufentanil and vecuronium.After induction of anesthesia,a loading dose of tranexamic acid l0 mg/kg was intravenously infused over 20 min before skin incision,followed by infusion at a rate of 10 mg · kg-1 · h 1 until the end of surgery in TA group,while the equal volume of normal saline was given instead in NS group.The volume of chest tube drainage at 24 h after surgery and volume of allogeneic red blood cells,fresh frozen plasma,platelet and cryoprecipitate transfused were recorded.The requirement for re-thoracotomy for bleeding,and the incidence of hepatic artery and portal vein thrombosis were also recorded.Results Compared to NS group,the volume of chest tube drainage at 24 h after surgery and volume of allogeneic red blood cells,fresh frozen plasma,platelet and cryoprecipitate transfused were significantly reduced in TA group.No re-thoracotomy was required in TA group,and the rate of re-thoracotomy was 15％ in NS group.No hepatic artery and portal vein thrombosis were detected in group TA.Conclusion Tranexamic acid (loading dose 10 mg/kg,maintenance dose 10 mg· kg-1 · h-1) can provide blood-saving effect and has high security in pediatric patients undergoing radical correction of tetralogy of Fallot with CPB.
