CAJ | 학술논문

目的：观察肝移植手术中采用不同剂量的氨甲环酸（TXA）对患者纤溶功能的影响。方法：60例拟行肝移植的患者随机、双盲分为3组（n ＝20），对照组（C组）、TXA1组（T1组）、TXA2组（T2组）。 C组：手术前经静脉给予10 mL生理盐水，随后20 mL／h泵注至新肝期120 min；T1组和T2组则给予1 g TXA共10 mL，随后T1组为10 mg／（kg·h），T2组为20 mg／（kg·h）泵注至新肝期120 min。于手术前（T0）、手术120 min （T1）、无肝期30 min（T2）、新肝期60 min（T3）测凝血酶原时间、纤维蛋白原、纤维蛋白降解产物、D－二聚体，记录术中出血量，新鲜冰冻血浆、纤维蛋白原用量，血栓栓塞事件。结果：T2、T3时纤维蛋白降解产物和D－二聚体水平T2组＜ T1组＜ C组，T2组的出血量和新鲜冰冻血浆输注量小于其他两组（P＜0．05），3组血栓栓塞发生率相似（P ＞0．05）。结论：术中输注TXA可抑制纤溶功能、不增加栓塞发生率；大剂量效果更好，减少术中出血，减少新鲜冰冻血浆的输注。
목적：관찰간이식수술중채용불동제량적안갑배산（TXA）대환자섬용공능적영향。방법：60례의행간이식적환자수궤、쌍맹분위3조（n ＝20），대조조（C조）、TXA1조（T1조）、TXA2조（T2조）。 C조：수술전경정맥급여10 mL생리염수，수후20 mL／h빙주지신간기120 min；T1조화T2조칙급여1 g TXA공10 mL，수후T1조위10 mg／（kg·h），T2조위20 mg／（kg·h）빙주지신간기120 min。우수술전（T0）、수술120 min （T1）、무간기30 min（T2）、신간기60 min（T3）측응혈매원시간、섬유단백원、섬유단백강해산물、D－이취체，기록술중출혈량，신선빙동혈장、섬유단백원용량，혈전전새사건。결과：T2、T3시섬유단백강해산물화D－이취체수평T2조＜ T1조＜ C조，T2조적출혈량화신선빙동혈장수주량소우기타량조（P＜0．05），3조혈전전새발생솔상사（P ＞0．05）。결론：술중수주TXA가억제섬용공능、불증가전새발생솔；대제량효과경호，감소술중출혈，감소신선빙동혈장적수주。
Objective To investigate the effects of different dose of tranexamic acid in fibrinolysis during liver transplantation. Methods Sixty ASA Ⅱ~ Ⅳ liver transplant recipients, were randomly, double-blind assigned to one of 3 groups (n = 20): group control (group C), group tranexamic acid 1 (group T1) and group tranexamic acid 2 (group T2). The patients in group C received a loading dose of normal saline 10 mL, then continued infuse normal saline at 20 mL/h until neohepatic phase 120 min, while in other two groups, patients received a loading dose of tranexamic acid 1 g, totally 10 mL, followed by continuous infusion at 10 mg/(kg·h) in group T1 or 20 mg/(kg·h) in group T2 until neohepatic phase 120 min. Prothrombin time, fibrinogen, fibrin degradation product and D-dimers were measured before operation (T0), 120 min after the skin incision (T1), nonhepatic phase 30 min (T2), neohepatic phase 120 min (T3). Blood loss, fresh frozen plasma dosage, fibrinogen dosage and thromboembolic events were recorded. Results The plasma concentration of fibrin degradation product and plasma concentration of D-dimers were different in the 3 groups, group T2< group T1<group C. The amount of blood loss and fresh frozen plasma transfusion in the group T2 were smaller than in the other two groups (P < 0.05). No thrombosis event was detected during perioperative period (P > 0.05). Conclusions Continuous infusion of tranexamic acid can inhibit fibrinolysis during liver transplantation. No adverse event of thrombosis was detected. Larger dose of tranexamic acid can reduce blood loss and fresh frozen plasma transfusion.