张红　周振锋

[摘要] 目的 探討氨甲环酸对心脏手术围术期凝血功能及术后脑梗死的影响。 方法 选取2017年2月～2018年2月来我院进行择期体外循环心脏手术的100例患者为研究对象，根据治疗方式的不同分为观察组和对照组，其中观察组60例，对照组40例，观察组患者手术麻醉后给予氨甲环酸治疗，对照组给予氯化钠治疗，比较两组患者围手术期凝血功能相关指标以及手术后脑梗死的发生情况。 结果 两组患者治疗前、后凝血酶原时间（prothrombin time， PT）、部分凝血酶时间（activated partial thromboplastin time，APTT）、凝血酶时间（thrombin time，TT）以及纤维蛋白原（fibrinogen，FIB）组间比较无显著差异（P>0.05）；治疗前两组患者的D-二聚体含量无显著差异，治疗后，观察组的含量显著低于对照组，差异有统计学意义（P<0.05）；观察组的脑梗死发生率为3.33%，与对照组的2.50%相比无显著差异（P>0.05）。 结论 氨甲环酸不会导致明显的体外循环心脏手术患者凝血功能的异常，患者术后发生脑梗死的概率较低，值得临床推广应用。

[关键词] 氨甲环酸；心脏手术；凝血功能；脑梗死

[中图分类号] R654.2 [文献标识码] B [文章编号] 1673-9701（2018）23-0129-04

Effects of tranexamic acid on perioperative coagulation function and postoperative infarction in cardiac surgery

ZHANG Hong ZHOU Zhenfeng

Department of Anesthesiology，Zhejiang Provincial People's Hospital，Hangzhou 310000，China

[Abstract] Objective To investigate the effect of tranexamic acid on perioperative coagulation function and postoperative cerebral infarction in cardiac surgery. Methods A total of 100 patients undergoing elective cardiopulmonary bypass surgery in our hospital from February 2017 to February 2018 were selected. According to different treatment methods they were divided into observation group（n=60） and control group（n=40）. The patients in the observation group were given tranexamic acid after anesthesia and the control group was given sodium chloride. The perioperative blood coagulation related indexes and the incidence of cerebral infarction after surgery were compared between the two groups. Results There was no significant difference in prothrombin time（PT）， activated partial thromboplastin time（APTT）， thrombin time（TT） and fibrinogen （FIB） before and after treatment between the two groups（P>0.05）. There was no significant difference in D-dimer content between the two groups before treatment. After treatment， the D-dimer content of the observation group was significantly lower than that of the control group， and the difference was statistically significant（P<0.05）. There was no significant difference in the incidence of cerebral infarction in the observation group（3.33%） and the control group（2.50%）（P>0.05）. Conclusion Tranexamic acid does not cause obvious abnormal coagulation in patients undergoing cardiopulmonary bypass surgery. The probability of postoperative cerebral infarction is low， and tranexamic acid is worthy of clinical application.

[Key words] Tranexamic acid；Cardiac surgery；Coagulation function；Cerebral infarction

心脏体外循环手术（cardiopulmonary bypass，CPB）是指在心脏、大血管手术过程中，通过管道将体内的大血管与人工心肺机连接[1，2]，在体外进行心肺转流，将静脉血引出，在体外氧合，然后输回动脉系统的过程[3，4]，随着医疗水平的提高，虽然其安全性不断完善，但仍不可避免地会对患者血液循环系统造成损伤[5，6]。目前，国际上建议在心脏体外循环手术过程中给予抗纤维蛋白溶解药物，减少围手术期的失血量，其中氨甲环酸最常用的抗纤溶药物[7，8]，但抗纤溶药物的使用可能会增加患者血栓形成的风险，故本研究主要探讨氨甲环酸对心脏手术围术期凝血功能及术后脑梗死的影响，旨在为氨甲环酸在临床的应用提供一定的理论依据，现报道如下。