CAJ | 학술논문

目的探讨氨甲环酸对Stanford A型主动脉夹层术患者的血液保护作用.方法急诊行Stanford A型主动脉夹层术患者56例,性别不限,年龄34～58岁,体重62～84 kg,ASA分级Ⅱ或Ⅲ级,左室射血分数＞40％.采用随机数字表法分为对照组(C组,n=26)和氨甲环酸组(TA组,n=30).TA组于切皮前经30 min静脉输注氨甲环酸负荷剂量10 mg/kg,继以10 mg·kg-1·h-1速率持续静脉输注至术毕;C组给予等容量生理盐水.记录术后24 h总引流量,术后异体红细胞、血浆及血小板使用量和二次开胸止血情况,记录术后机械通气时间、ICU停留时间及术后并发症发生情况.结果与C组比较,TA组术后24 h总引流量和术后异体红细胞、血浆及血小板用量减少,二次开胸止血率降低,机械通气时间和ICU停留时间缩短,术后急性肺损伤和短暂性神经功能障碍发生率降低(P＜0.05).结论氨甲环酸对Stanford A型主动脉夹层术患者具有血液保护作用,可减少术后出血与异体输血.
목적 탐토안갑배산대Stanford A형주동맥협층술환자적혈액보호작용.방법 급진행Stanford A형주동맥협층술환자56례,성별불한,년령34～58세,체중62～84 kg,ASA분급Ⅱ혹Ⅲ급,좌실사혈분수＞40％.채용수궤수자표법분위대조조(C조,n=26)화안갑배산조(TA조,n=30).TA조우절피전경30 min정맥수주안갑배산부하제량10 mg/kg,계이10 mg·kg-1·h-1속솔지속정맥수주지술필;C조급여등용량생리염수.기록술후24 h총인류량,술후이체홍세포、혈장급혈소판사용량화이차개흉지혈정황,기록술후궤계통기시간、ICU정류시간급술후병발증발생정황.결과 여C조비교,TA조술후24 h총인류량화술후이체홍세포、혈장급혈소판용량감소,이차개흉지혈솔강저,궤계통기시간화ICU정류시간축단,술후급성폐손상화단잠성신경공능장애발생솔강저(P＜0.05).결론 안갑배산대Stanford A형주동맥협층술환자구유혈액보호작용,가감소술후출혈여이체수혈.
Objective To investigate the blood-saving effect of tranexamic acid in patients undergoing Stanford type A aortic dissection surgery.Methods Fifty-six patients of both sexes with acute Stanford type A aortic dissection, aged 34-58 yr, weighing 62-84 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ , with their left ventricular ejection fraction ＞ 40％, undergoing emergency surgery, were randomly divided into 2 groups: control group (group C, n=26) and tranexamic acid group (group TA, n=30).Tranexamic acid was infused as a bolus of 10 mg/kg over 30 min before skin incision followed by an infusion of 10 mg · kg-1 · h-1 throughout the surgery in group TA.The equal volume of normal saline was given instead in group C.The total volume of drainage at 24 h after operation, the postoperative requirement of allogeneic red blood cells, fresh frozen plasma and platelets, and re-thoracotomy for bleeding were recorded.The postoperative mechanical ventilation time, duration of intensive care unit stay, and complications after operation were also recorded.Results Compared with group C, the total volume of drainage at 24 h after operation, and the requirement of allogeneic red blood cells, fresh frozen plasma and platelets were significantly reduced, the incidence of rethoracotomy for bleeding was decreased, the postoperative mechanical ventilation time, and duration of intensive care unit stay were shortened, and the incidence of postoperative acute lung injury and transient neurological dysfunction were decreased in group TA.Conclusion Tranexamic acid has blood-saving effect and can reduce postoperative bleeding and allogeneic blood transfusion in patients undergoing Stanford type A aortic dissection surgery.