The Blood Conservation Efficacy And Safety Of Different Tranexamic Acid And Ulinastain Administration Methods In Cardiac Mitral Valve Replacement With Cardiopulmonary Bypass

Objective:To evaluate the blood conservation effectivity and security of different tranexamic acid (TA) and ulinastain (UTI) administration methods during and after cardiac mitral valve replacement with cardiopulmonary bypass (CPB) by observing coagulation function and postoperative bleeding, giving reasonable theories on using antifibrinolytic activation agents in clinic.Methods:Choosing patients undergoing mitral valve replacement with use of CPB (n=100) in the First Hospital of Lanzhou University from October 2012 to December 2014, they were randomly divided into four groups:group A (n=25), large dose of TA with UTI; group B (n=25), small dose of TA with UTI; group C (n=25), single-dose TA with UTI; group D (n=25), placebo group. Group A, administered with TA 20 mg/kg after anesthesia induction (intravenous injection slowly), followed by infusion of TA 20 mg/(kg·h); Group B, administered with TA 10 mg/kg after anesthesia induction (intravenous injection slowly),followed by infusion of TA 10 mg/(kg·h); Group C, given the single-dose TA 50 mg/kg (intravenous injection slowly); Group D with normal saline. Group A, B, C were join UTI (300000U/kg) intravenous before CPB, the priming solution of CPB, starting CPB respectively; Group D with normal saline. Blood routine and coagulation function were assessed after anesthesia induction (TO), after protamine neutralization (T1), the ending of surgery (T2), after surgery 12 hours (T3) and 24 hours (T4). Observing and recording the amount of mediastinal and pericardial volume of drainage in 0～6h、7～12h、13～18h、19～ 24h.Results:No significant differences were found in patients’ basic information before operation in group A, B, C, D (P>0.05). Hemoglobin (Hb), platelet (Plt), hematocrit (Hct), data of coagulation function measured values on admission and pre-operation were not statistically significant between the four group (P>0.05), moreover, data of each variable fitted normal distribution (P>0.05). Four groups with Hb and Plt change is:The data measured in T1, T2, T3, T4, compared with TO were significant difference (P<0.05) in four group. Each time point but TO compared two groups, group A, B compared with group C, D were significant difference (P<0.05), but no significant differences were found in group A and group B. Four groups with coagulation data change is:Prothrombintime (PT), fibrinogen (FIB), activated partial thromboplastin time (APTT), D-Dimer (D-D) were measured in T1, T2, T3, T4, compared with TO were significant difference (P<0.05) in four group. International normalized ratio (INR) were measured in T1, T2, T3, compared with TO were significant difference (P<0.05) in four group, but INR were measured in T4 compared with TO no significant differences (P>0.05). Compared two groups in T1 and T2, there were significant difference between group A, B, C and group D (P<0.05), but no significant differences (P>0.05) between group A and group B. Compared two groups in T3, there were significant difference between group A, B, C and group D (P<0.05). Compared two groups in T4, PT, FIB, D-D were significant difference in four groups (P<0.05), but INR, APTT no significant differences (P>0.05). The time of sternal closure:No significant differences were found in group A and group B (P>0.05). There were significant difference between group A, B, C and group D (P<0.05). Volume of drainage:There were significant difference between four group but group A between group B (P<0.05).Conclusion:TA and UTI can protect hemoglobin, platelet and anti-fibrinolytic. UTI with large dose of TA and UTI with small dose of TA show advantage in blood conservation than UTI with single-dose TA and placebo group. But there is no difference in UTI with large dose of TA and UTI with small dose of TA. It shows that increase drug dosages cannot improve the function of coagulation and reduce bleeding. In conclusion, UTI with small dose of TA continuous infusion have efficacy and safety of blood conservation, furthermore, it has clinical feasibility.