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体外循环后使用氨甲环酸对患者预后的影响

刘静, 陈长伟, 黄豆, 罗丹, 杜磊

刘静, 陈长伟, 黄豆, 等. 体外循环后使用氨甲环酸对患者预后的影响[J]. 四川大学学报（医学版）, 2018, 49(4): 660-664.
引用本文: 刘静, 陈长伟, 黄豆, 等. 体外循环后使用氨甲环酸对患者预后的影响[J]. 四川大学学报（医学版）, 2018, 49(4): 660-664.
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LIU Jing, CHEN Chang-wei, HUANG Dou, et al. Effects of Tranexamic Acid after Cardiopulmonary Bypass on the Outcomes of Patients Undergoing Cardiac Surgery[J]. Journal of Sichuan University (Medical Sciences), 2018, 49(4): 660-664.
Citation: LIU Jing, CHEN Chang-wei, HUANG Dou, et al. Effects of Tranexamic Acid after Cardiopulmonary Bypass on the Outcomes of Patients Undergoing Cardiac Surgery[J]. Journal of Sichuan University (Medical Sciences), 2018, 49(4): 660-664.
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栏目: 临床医学

体外循环后使用氨甲环酸对患者预后的影响

  • 四川大学华西医院 麻醉科(成都 610041)

基金项目: 

国家自然科学基金（No.81570374）资助

Effects of Tranexamic Acid after Cardiopulmonary Bypass on the Outcomes of Patients Undergoing Cardiac Surgery

  • Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China

摘要

    摘要
  • 摘要: 目的 探讨体外循环后使用氨甲环酸（TXA）对患者预后的影响。 方法 收集2011年7月1日至2016年12月31日在四川大学华西医院行择期体外循环下瓣膜手术和/或冠状动脉旁路移植术的成人患者（≥ 18岁），将患者分为TXA组（n=2 062）和对照组（n=4 236），前者均在体外循环后接受TXA的输注，后者均未接受任何TXA的输注。分析两组患者术后并发症（包括死亡、大量失血、缺血性事件和出血性事件）、ICU时长及住院时长的差异，采用logistic回归研究TXA对患者预后的影响。 结果 TXA组患者大量出血率和心包纵膈引流量低于对照组患者（P<0.05），但死亡率、缺血性事件发生率和出血性事件发生率两组相似（P>0.05）。Logistic回归分析显示，体外循环后使用TXA可降低术后大出血风险（OR：0.55，95%CI：0.49~0.62，P<0.001）和死亡风险（OR：0.55，95%CI：0.30~0.98，P=0.044），但不影响缺血性事件和出血性事件。 结论 体外循环后使用TXA可降低术后大出血风险和死亡风险，但不增加缺血性事件的发生。

     

    Abstract: Objective To determine the effect of tranexamic acid (TXA) after cardiopulmonary bypass (CPB) on the outcomes of cardiac surgery patients. Methods This retrospective study included adult patients (≥ 18 years old) who underwent elective valve replace surgery and/or coronary artery bypass surgery (CABG) with CPB from July 1, 2011 to December 31, 2016 in West China Hospital of Sichuan University. The patients were divided into TXA group (n=2 062), who received TXA after CPB, and the control group (n=4 236), who did not receive any TXA at all. The differences in postoperative complications such as death, excessive bleeding, ischemic event and bleeding related event, ICU and hospitality duration of the two groups were analyzed. Logistic regression analysis was performed to examine the effects of TXA on the outcomes of the patients. Results The rate of excessive bleeding and the median chest tube drainage of TXA group were less than those of control group (P<0.05), while the incidences of death, ischemic event and bleeding related event were comparable between the two groups (P>0.05). Multivariable regression analysis showed TXA after CPB was associated with the reduced risks of excessive bleeding[odds ratio (OR):0.55, 95%confidence interval (CI):0.49-0.62, P<0.001] and death (OR:0.55, 95%CI:0.30-0.98, P=0.044), but was not associated with ischemic event and bleeding related event. Conclusion TXA after CPB following cardiac surgery could reduce the risk of excessive bleeding and death without increase of ischemic event.

     

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出版历程
  • 收稿日期:  2018-01-31
  • 修回日期:  2018-05-23
  • 发布日期:  2018-07-19

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