2018 年第 12 期 第 13 卷

氨甲环酸联合乌司他丁对非体外循环冠状动脉旁路移植术患者凝血功能的影响

Effect of tranexamic acid combined with ulinastatin on coagulation function in patients undergoing off-pump coronary artery bypass grafting

作者：徐桂萍李婷

英文作者：

单位：830001乌鲁木齐，新疆维吾尔自治区人民医院麻醉科

英文单位：

关键词：冠状动脉旁路移植术；氨甲环酸；乌司他丁；凝血功能

英文关键词：

• 摘要：

• 【摘要】目的    观察氨甲环酸联合乌司他丁对非体外循环冠状动脉旁路移植术患者凝血功能的影响。方法    选取2017年4月至2018年4月在新疆维吾尔自治区人民医院择期行非体外循环冠状动脉旁路移植术的患者80例，应用随机数字表法将患者分为对照组、氨甲环酸组、乌司他丁组、联合组，每组20例。手术开始时，联合组静脉注射氨甲环酸20 mg/kg和乌司他丁10 000 U/kg，氨甲环酸组静脉注射氨甲环酸20 mg/kg，乌司他丁组静脉注射乌司他丁10 000 U/kg，对照组静脉注射等容量0.9%氯化钠注射液。比较4组术中总失血量、术后输血量、术后6 h引流量、呼吸机支持时间、术后2 d血小板计数、血红蛋白、血细胞比容、白细胞计数、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原、D-二聚体数值。结果    氨甲环酸组、乌司他丁组、联合组术中总出血量、术后输血量、术后6 h引流量、呼吸机支持时间均明显少于/短于对照组［（156±25）、（159±29）、（103±24）ml比（210±17）ml，（3.9±0.7）、（3.7±1.0）、（3.1±0.4）U比（4.7±1.3）U，（166±100）、（198±100）、（131±87）ml比（310±99）ml，（14.5±3.8）、（14.9±3.6）、（10.6±2.1）h比（17.3±5.2）h］；联合组各指标均少于/短于氨甲环酸组和乌司他丁组，差异均有统计学意义（均P＜0.05）。4组患者术后血小板计数、血红蛋白、血细胞比容、白细胞计数比较，差异均无统计学意义（均P＞0.05）。氨甲环酸组、乌司他丁组、联合组PT、APTT、D-二聚体水平明显低于对照组［（17.1±2.2）、（17.2±2.0）、（12.2±1.9）s比（25.2±3.1）s，（65±18）、（69±12）、（54±17）s比（81±16）s，（2.01±0.21）,（2.23±0.34）,（1.52±0.17）mg/L比（3.40±0.22）mg/L］，纤维蛋白原水平高于对照组［（1.43±0.02）,（1.35±0.13）,（1.71±0.24）g/L比（1.02±0.11）g/L］；联合组PT、APTT、D-二聚体水平明显低于、纤维蛋白原水平明显高于氨甲环酸组和乌司他丁组，差异均有统计学意义（均P＜0.05）。结论    氨甲环酸、乌司他丁均能有效地抑制纤溶系统，二者联用能够达到更好的止血效果。

• 【Abstract】Objective    To evaluate the effect of tranexamic acid combined with ulinastatin on coagulation function in patients undergoing off-pump coronary artery bypass grafting. Methods    Eighty patients undergoing off-pump coronary artery bypass grafting were enrolled from April 2017 to April 2018 in People′s Hospital of Xinjiang Uygur Autonomous Region. They were randomly assigned into 4 groups（n＝20）: control group, tranexamic acid group, ulinastatin group and combination group. Before surgery, the combination group had intravenous injection of tranexamic acid 20 mg/kg and ulinastatin 10 000 U/kg; the tranexamic acid group had intravenous injection of tranexamic acid 20 mg/kg; the ulinastatin group had intravenous injection of ulinastatin 10 000 U/kg; the control group had intravenous injection of 0.9% sodium chloride solution. Intraoperative blood loss, postoperative transfusion volume, postoperative 6 h drainage volume, ventilator support time were recorded. Platelet count, hemoglobin, erythrocrit, leucocyte count, prothrombin time（PT）, activated partial thromboplastin time（APTT）, fibrinogen and D-dimer were tested 2 d after operation. Results      Intraoperative blood loss, postoperative transfusion volume, postoperative 6 h drainage volume and ventilator support time in the tranexamic acid group, ulinastatin group and combination group were significantly less/shorter than those in the control group［（156±25）,（159±29）,（103±24）ml vs （210±17）ml; （3.9±0.7）,（3.7±1.0）,（3.1±0.4）U vs （4.7±1.3）U; （166±100）,（198±100）,（131±87）ml vs （310±99）ml; （14.5±3.8）,（14.9±3.6）,（10.6±2.1）h vs （17.3±5.2）h］； the indexes in the combination group were significantly less/shorter than those in the tranexamic acid group and ulinastatin group（P＜0.05）. Platelet count, hemoglobin, erythrocrit and leucocyte count showed no significant difference among the four groups（P＞0.05）. PT, APTT and D-dimer in the tranexamic acid group, ulinastatin group and combination group were significantly lower and fibrinogen was higher than those in the control group［（17.1±2.2）,（17.2±2.0）,（12.2±1.9）s vs （25.2±3.1）s; （65±18）,（69±12）,（54±17）s vs （81±16）s; （2.01±0.21）,（2.23±0.34）,（1.52±0.17）mg/L vs （3.40±0.22）mg/L; （1.43±0.02）,（1.35±0.13）,（1.71±0.24）g/L vs （1.02±0.11）g/L］; PT, APTT and D-dimer in the combination group were significantly lower and fibrinogen was significantly higher than those in the tranexamic acid group and ulinastatin group（P＜0.05）. Conclusion    Both tranexamic acid and ulinastatin can effectively inhibit fibrinolytic system.