氨甲环酸不同给药方式对心脏瓣膜置换术患者的效果差异和安全性分析

目的:探讨氨甲环酸不同给药方式对心脏瓣膜置换术患者的效果差异和安全性。方法:选择2016年7月至2019年11月我院接诊的112例接受体外循环下心脏瓣膜置换术的患者,通过随机数表法分为三组,A组38例,B组38例,C组36例。A组在切皮前给予氨甲环酸注射液10 mg/kg单次静脉推注,B组在切皮前给予氨甲环酸注射液10 mg/kg的单次静脉推注后,之后再以5mg/kg/h的速度持续静脉泵注,直至手术结束;C组不使用氨甲环酸。比较三组围术期情况、不同时间点凝血功能及引流量的变化,并评价安全性。结果:通过对三组患者的术后24 h出血量、输液量、异体红细胞输血例数和输血量进行对比,结果显示,A组和B组上述情况均比对照组少(P<0.05),但A组和B组患者上述情况经过比较显示,差异无统计学意义(P>0.05);在手术结束时(T1)、术后6 h(T2)、术后12 h(T3)、术后24 h(T4)时点时,A组和B组患者的血小板计数(PLT)、血红蛋白(Hb)、纤维蛋白原(FIB)水平的结果均比C组高,活化部分凝血活酶时间(APTT)、国际标准化比值(INR)、D-二聚体(D-D)水平的结果均明显比C组低(P<0.05),但A组和B组患者在上述时间点各指标进行比较,差异无统计学意义(P>0.05);A组和B组患者在T2、T3、T4时点时引流量均比对照组低(P<0.05),但是A组和B组术后各时间点引流量的比较结果显示,差异无统计学意义(P>0.05);A组和B组术后肾功能损伤发生率比较差异有统计学意义(P<0.05)。结论:氨甲环酸对心脏瓣膜置换术患者具有血液保护作用,但和单次静脉推注氨甲环酸相比,术中持续泵注氨甲环酸并没有进一步改善患者术后凝血功能、出血量及引流量,且有增加肾损伤的风险,在临床应用上应注意药物使用方式,为患者提供更安全的用药方式。

Analysis of the Effect Difference and Safety of Different Ways of Administration Tranexamic Acid in Patients Undergoing Heart Valve Replacement

Objective: To study the analysis of the effect difference and safety of different ways of administration tranexamic acid in patients undergoing heart valve replacement. Methods: 112 cases underwent heart valve replacement under extracorporeal circulation were selected from July 2016 to November 2019 in our hospital were selected, according to the random number table, those patients were divided into 3 groups, 38 cases in A group, 38 cases in B group and 36 cases in C group. The A group was given a single intravenous injection of tranexamic acid 10 mg/kg before skin cutting, the B group was given a single intravenous injection of tranexamic acid 10 mg/kg before skin cutting, and then continued intravenous pumping at the rate of 5 mg/kg/h until the end of the operation;the C group did not use tranexamic acid. The perioperative situation, the changes of blood coagulation function and induced flow at different time points were compared among the three groups, and the safety was evaluated. Results: The blood loss, transfusion volume, cases of allogeneic red blood cell transfusion and blood transfusion volume were compared among the three groups, the results showed that A group and B group were less than the control group(P<0.05);but there was no significant difference in the above situation between A group and B group(P>0.05);at the end of operation(T1), postoperative 6 h(T2), postoperative 12 h(T3) and postoperative 24 h(T4) points, the platelet count(PLT), hemoglobin(Hb) and fibrinogen(FIB) levels in the A group and B group were significantly higher than those in the C group, the activated partial thromboplastin time(APTT), international normalized ratio(INR) levels were significantly lower than those in the C group(P<0.05), there was no significant difference between the A group and B group at the above time points(P>0.05);at T2,T3 and T4 time points, the induced flow in the A group and B group was lower than that the C group(P<0.05), there was no significant difference in the induced flow between the A group and B group(P>0.05);there was significant difference in the incidence of renal function injury between the A group and B group(P<0.05). Conclusion: Tranexamic acid has a blood protective effect on patients undergoing heart valve replacement. However, compared with single intravenous injection of tranexamic acid, continuous pump injection of tranexamic acid during the operation does not further improve the postoperative coagulation function, blood loss and induced flow, and it also increases the risk of renal injury, in clinical application, we should pay attention to the way of drug use, so as to provide patients with a safer way of drug use.