Abstract
目的 观察氨甲环酸减少体外循环(CPB)心脏手术后失血的作用,探讨其作用机制,并与抑肽酶比较.方法 随机选取CPB心脏手术病人30例,分为氨甲环酸用药组(TA组,10例),抑肽酶用药组(AP组,10例)和对照组(C组,10例).于CPB前、中、后2h分别测定t-PA和PAI-1活性、TXB2和6-keto-PGF1α含量、ADP诱导的血小板最大聚集率和血小板超微结构变化,记录各组术后纵隔心包引流量.结果 转流中TA组t-PA活性升高和PAI-1活性下降明显小于另2组(P＜0.01);与对照组和TA组相比,AP组转流中TXB2含量升高明显减轻(P＜0.01),TXB2/6-keto-PGF1α值下降,ADP诱导的血小板最大聚集率降低(P＜0.05),血小板超微结构破坏程度减小;TA组和AP组术后24h失血分别为(7.379±1.955)ml/kg和(6.969±2.107)ml/kg,均比对照组(10.001±2.277)ml/kg明显减少(P＜0.05),用药两组间差异无显著性(P＞0.05).结论 氨甲环酸明显抑制了CPB引起的t-PA活性增高,并可显著减少术后失血,与抑肽酶相比,作用相似,但未表现出对血小板的保护作用.
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