不同剂量氨甲环酸在体外循环心脏手术应用效果

发布时间：2018-05-12 14:54

本文选题：心脏手术 + 体外循环　；参考：《北京协和医学院》2015年硕士论文

【摘要】：目的氨甲环酸是一种人工合成的抗纤溶药物,预防应用具有减少体外循环心脏手术后出血和异体输血的作用。但是氨甲环酸在体外循环心脏手术最佳用药剂量尚未确定。本研究目的是比较三种不同剂量的氨甲环酸用于体外循环心脏手术减少出血和异体输血的效果。方法本研究为前瞻性、随机、双盲试验。选择从2012年9月至2014年9月,年龄18岁到75岁之间在阜外医院行择期体外循环心脏手术的患者,共955例,包括冠状动脉旁路移植术、心脏瓣膜成形或置换、非紫绀型先天性心脏病、心房粘液瘤和肥厚梗阻性心肌病。所有患者随机分成三组,手术开始时给予氨甲环酸。小剂量组在15分钟内给予10mg/kg的负荷量,随后给予2mg/kg/h的维持量,体外循环预充液中加入10mg/kg的预充量。中剂量组在15分钟内给予20mg/kg的负荷量,随后给予4mg/kg/h的维持量,体外循环预充液中加入20mg/kg的预充量。大剂量组在15分钟内给予30mg/kg的负荷量,随后给予6mg/kg/h的维持量,体外循环预充液中加入30mg/kg的预充量。记录术后6小时和24小时内的胸管引流液量,记录术后7天内所有使用异体血的病例数和输血量,记录并发症的发生率。结果使用大、中、小剂量氨甲环酸的三组之间术后6小时和24小时的胸管引流液量比较无统计学意义,三组之间需要输异体血的病例数,以及输血的患者所使用的异体血用量也没有显著差异。各组间术后7天内并发症的发生率无显著差异。结论使用小剂量、中剂量和大剂量氨甲环酸对减少体外循环心脏手术术后胸液量、输血量和输血率的作用效果相同。
[Abstract]:Objective Ammonocycline is a synthetic antifibrinolytic drug, which can reduce bleeding and allogeneic blood transfusion after cardiopulmonary bypass (CPB). However, the optimal dosage of carbamate in cardiopulmonary bypass heart surgery has not been determined. The purpose of this study was to compare the effects of three different doses of carbamate on reducing bleeding and allogeneic blood transfusion during cardiopulmonary bypass (CPB). Methods the study was prospective, randomized and double blind. From September 2012 to September 2014, a total of 955 patients, aged 18 to 75 years, underwent elective cardiopulmonary bypass heart surgery in Fuwei Hospital, including coronary artery bypass grafting, heart valve plasty or replacement. Cyanotic congenital heart disease, atrial myxoma and hypertrophic obstructive cardiomyopathy. All patients were randomly divided into three groups. In the low dose group, the loading of 10mg/kg was given within 15 minutes, then the maintenance of 2mg/kg/h was given, and the precharge of 10mg/kg was added to the cardiopulmonary bypass (CPB). In the middle dose group, the loading of 20mg/kg was given within 15 minutes, then the maintenance of 4mg/kg/h, and the precharge of 20mg/kg was added to the cardiopulmonary bypass (CPB). In the high dose group, the load of 30mg/kg was given within 15 minutes, then the maintenance of 6mg/kg/h was given, and the precharge of 30mg/kg was added to the cardiopulmonary bypass (CPB). The amount of drainage fluid was recorded at 6 hours and 24 hours after operation, the number of cases using allogeneic blood and the amount of blood transfusion were recorded 7 days after operation, and the incidence of complications was recorded. Results there was no significant difference in the amount of thoracic tube drainage between the three groups using large, medium and small doses of carbamoic acid at 6 hours and 24 hours after operation, and the number of cases with allogeneic blood transfusion between the three groups was not statistically significant. There was also no significant difference in the amount of allogeneic blood used in patients with blood transfusions. There was no significant difference in the incidence of complications within 7 days after operation among the groups. Conclusion the effects of low, medium and high doses of carbamate on reducing the amount of pleural effusion, blood transfusion and blood transfusion rate after cardiopulmonary bypass heart surgery are the same.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614

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