摘要
目的 评价术后患者追加使用氨甲环酸或联用白眉蛇毒血凝酶进行止血的疗效和安全性.方法 回顾性纳入2018年1月～2019年12月体外循环下心脏瓣膜置换术中均接受氨甲环酸1 g进行止血的患者,根据术后使用的止血药物将患者分为空白对照组(C组)、氨甲环酸组(T组)和氨甲环酸联用白眉蛇毒血凝酶组(TH组).比较3组的出血情况、血液制品输注量、心包纵膈总引流量及引流天数、重症监护室停留时长、机械通气时长、术后住院天数、凝血功能、肝功能和血栓栓塞事件发生率以及人纤维蛋白原输注率等指标差异.结果 共纳入心脏瓣膜置换术患者234例,3组患者出血情况、血液制品输注量、机械通气时长、术后住院天数、肝功能和栓塞事件发生率比较,差异均无统计学意义.TH组心包纵膈总引流量[910.00(700.00～1 250.00)mL]和引流天数[6.00(4.00～7.00)d]均较 C 组[660.00(510.00～815.00)mL;4.00(4.00～6.00)d]和 T组[580.00(426.50～827.50)mL;4.00(4.00～5.18)d]增加(P＜0.001),TH 组重症监护室停留时间[22.00(18.30～40.60)h]长于T组[18.90(17.85～34.10)h](P＜0.05).与 C 组[1 d:2.94(2.44～3.41)g·L-1;2 d:4.73(4.19～5.03)g·L-1]和T 组[1 d:2.99(2.70～3.37)g·L-1;2 d:4.81(4.16～5.23)g·L-1]相比,TH 组在术后 1 d[1.65(1.39～1.93)g·L-1]和 2 d[2.76(2.10～3.44)g·L-1]的血浆纤维蛋白原(fibrinogen,Fbg)显著降低(P＜0.001),导致人纤维蛋白原输注率增加(P＜0.001).结论 在体外循环心脏瓣膜置换术后追加使用氨甲环酸或氨甲环酸联用白眉蛇毒血凝酶均未能改善出血情况,且术后应用白眉蛇毒血凝酶可能引起Fbg降低、人纤维蛋白原输注率增加.
Abstract
OBJECTIVE To compare the effectiveness and safety of postoperative tranexamic acid(TXA)and its combination with hemocoagulase agkistrodon(HA)in patients undergoing cardiac valve replacement with cardiopulmonary bypass(CPB).METHODS This was a retrospective study of patients receiving TXA with 1 g during the intraoperative period between January 1,2018 and December 31,2019.According to the postoperative administration of hemostatic agents,the patients were assigned to the control group(Group C),the TXA group(Group T)and TXA's combination with HA group(Group TH).The clinical outcomes included the blood loss,transfusion of blood products,the overall pericardial drainage volume,days of pericardial drainage(days),length of intensive care unit(ICU)stay(hours),duration of mechanical ventilation(hours),days of postoperative hospitalization(days),coagulation function,hepatic function,the incidences of thromboembolic events and human fibrinogen transfusion events.RESULTS Among three groups,there were no significant differences in the blood loss,transfusion of blood products,duration of mechanical ventilation,days of postoperative hospitalization,hepatic function,and the incidence of thromboembolic events.Increased total pericardial drainage volume[910.00(700.00-1 250.00)mL]and days of pericardial drainage[6.00(4.00-7.00)days]were found in Group TH compared with Group C[660.00(510.00-815.00)mL;4.00(4.00-6.00)days]and T[580.00(426.50-827.50)mL;4.00(4.00-5.18)days](P＜0.001).Group TH had longer length of ICU stay[22.00(18.30-40.60)days]than Group T[18.90(17.85-34.10)days](P＜0.05).Moreover,lower fibrinogen levels and corresponding higher frequency of human fibrinogen transfusion were found in Group TH,as compared to those in Groups C and T(P＜0.001).CONCLUSION Bleeding events after cardiac valve replacement with CPB are not improved by postoperative administration of additional TXA and the combination with HA.HA is probably related to hypofibrinogenemia and increased transfusions of human fibrinogen.
维普
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