小儿室间隔缺损修补术中乌司他丁及氨甲环酸联用的效果及临床意义

刘延芹1，李素玲1，赵海涛1，赵砚丽1，高义1，杨永辉2

(1河北省儿童医院，石家庄050031；2河北省胸科医院)

摘要：目的观察小儿室间隔缺损修补术中联合应用乌司他丁及氨甲环酸的临床效果,探讨其临床意义。方法选取室间隔缺损患儿200例，按照随机数字法分为A组、B组、C组及对照组,每组各50例。择期行室间隔缺损修补术，四组均于麻醉诱导后给药：A组静脉注射乌司他丁10 000 U/kg，B组静脉注射氨甲环酸注射液20 mg/kg，C组静脉注射氨甲环酸注射液20 mg/kg及乌司他丁10 000 U/kg，对照组静脉注射同等体积生理盐水。记录术中心包引流量及冰冻血浆输注量。手术前及手术结束12 h后自中心静脉导管取血，检测血清炎症指标(TNF-α、IL-6、IL-10)及凝血指标(中性粒弹性蛋白酶、PT、APTT)。结果A、B、C组术中心包引流量及冰冻血浆输注量均少于对照组，且C组少于A、B组(P均<0.05)。A、B、C组血清TNF-α及IL-6水平均低于对照组，且C组低于A、B组；A、B、C组血清IL-10水平高于对照组，且C组高于A、B组；A、B、C组血清弹性蛋白酶水平、PT、APTT均低于对照组，且C组低于A、B组(P均<0.05)。结论 小儿室间隔缺损修补术中联合应用乌司他丁及氨甲苯酸具有较好的止血作用，可减少术中心包引流量及输血量，可能与促进凝血功能及抑制炎症反应有关。

关键词：乌司他丁；氨甲环酸；室间隔缺损；炎症；凝血

doi：10.3969/j.issn.1002-266X.2015.42.002

中图分类号：R654.2 文献标志码：A

基金项目：河北省医学科学研究重点课题计划资助项目(20110015)。

作者简介：第一刘延芹(1972-)，女，硕士，副主任医师，研究方向为小儿麻醉。E-mail: liuyanqin002@126.com

作者简介：通信杨永辉(1972-)，男，硕士，主任医师，研究方向为临床病理及病理生理。E-mail: yangyonghui002@126.com

收稿日期：(2015-05-23)

Effect of ulinastatin and tranexamic acid on inflammatory and coagulation indexes

in children undergoing ventricular septal defect repair

LIUYan-qin1, LI Su-ling, ZHAO Hai-tao, ZHAO Yan-li, GAO Yi, YANG Yong-hui

(1Children′sHospitalofHebeiProvince,Shijiazhuang050031,China)

Abstract:ObjectiveTo explore the effect of ulinastatin and tranexamic acid on inflammatory and coagulation indexes in children undergoing ventricular septal defect repair. MethodsA total of 200 children diagnosed with ventricular septal defect were divided into four groups, 50 cases in each group: ulinastatin group (group A), tranexamic acid group (group B), combination group (group C) and the control group. The volume of drainage from pericardium and frozen plasma infusion volume during the operation were recorded. We took the blood from the central venous catheter before and 12 hours after operation to detect the serum inflammatory indexes, including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-10 (IL-10), and coagulation indexes, including neutral grain of elastase, prothrombin time (PT) and activated partial thromboplastin time (APTT).ResultsThe volume of drainage from pericardium and frozen plasma infusion volume of the groups A, B and C were less than that of the control group, and the combination group was less than the other groups ( all P<0.05). The serum levels of TNF-α and IL-6 in the groups A, B and C were lower than that of the control group, and group C was lower than the other two groups; the serum level of IL-10 in the groups A, B and C were higher than that of the control group, and group C was higher than the other two groups; the serum levels of elastase, PT and APTT in the groups A, B and C were lower than that of the control group, and group C was lower than the other two groups (all P<0.05).ConclusionThe ulinastatin and aminomethylbenzoic acid have hemostatic and anti-inflammatory effect in children undergoing ventricular septal defect repair, which can reduce the volume of drainage from pericardium and frozen plasma infusion volume during the operation, and it may be related with the promotion of coagulation and inhibition of inflammatory reaction.

Key words: ulinastatin; aminomethylbenzoic acid; ventricular septal defect; inflammation; coagulation

大型室间隔缺损一般采用体外循环直视下行手术修补，而体外循环可严重干扰凝血功能，导致血小板减少、纤溶系统失衡等，造成术中出血[1～3]。此外，体外循环过程中使用的异体物质及异体血液可激活体内中性粒细胞、内皮细胞等，导致多种促炎介质释放，形成全身炎症反应综合征，进一步加重了出血的风险。……