| Subject:To observe the myocardial and blood protective effects of tranexamic acid(TxA)administration in cardiopulmonary bypass(CPB)valve surgery.Methods:A total of 60 patients with heart valve replacement undergoing cardiopulmonary bypass were randomly divided into three groups:intravenous group(group A),intracardiac injection group(group B)and combined group(group C),with 20 patients in each group.All patients in the three groups were operated by the same surgeon,anesthesiologist and cardiopulmonary bypass physician.Group A was intravenously given TxA loading dose of 10mg/kg within 20 min after induction of anesthesia,and then A maintenance dose of 10mg/(kg·h)was continuously pumped during operation.In group B,2.5gTxA was injected into the pericardium after protamine injection and before chest closure.Group C was given TxA according to the administration method and dose of groups A and B.Recorded the following indicators:(1)operation time,aortic occlusion time,cardiopulmonary bypass assisted time,rebounding mode after opening(automatic rebounding or electrical defibrillation);(2)The type and quantity of blood products used during the operation;(3)Postoperative pericardial and mediastinal drainage volume;(4)Intubation time and length of ICU stay;(5)Types and quantities of blood products used in ICU;(6)Surgical complications;(7)Red blood cell count(WBC),platelet count(PLT),hemoglobin(HGB),white blood cell count(WBC)before operation and 3 days after operation;Blood urea(BUN),creatinine(Cr),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CPR),troponin-I(cTnI)concentration,coagulation(APTT,INR)before and 3 days after surgery;Results:(1)There was no difference in preoperative basic data among three groups;(2)The usage of suspended red blood cells in ICU in group C was significantly lower than that in the other two groups(P<0.05),and there was no difference in the usage of platelet and plasma in ICU among the three groups(P>0.05).(3)Compared with the other two groups,the postoperative pericardial and mediastinal drainage in group C was significantly decreased(P<0.05);(4)Compared with group B,the levels of urea and creatinine in groups A and C increased 3 days after operation(P<0.05);(5)The levels of TNF-α,IL-6,CPR and WBC in the three groups at 3 days after operation were higher than those before operation,showing an upward trend,and TNF-α,IL-6 and CPR in group C were lower than those in the other two groups at 2 and 3 days after operation(P<0.05).(6)cTnI in the three groups at 3 days after operation was higher than that before operation,showing an upward trend,and cTnI in group C was lower than that in the other two groups at 3 days after operation(P<0.05).(7)No vascular embolism or death occurred in the postoperative complications of the three groups;There was no difference in the incidence of acute renal function loss,the rate of second thoracotomy and the rate of mechanical assistance among the three groups(P>0.05).Conclusions:(1)The clinical application of intracardiac local injection of TxA combined with intravenous small dose of TxA can reduce the postoperative blood loss and the amount of suspended red blood cells in cardiac valve surgery under cardiopulmonary bypass,and the effect of the combination is better than that of the two alone;(2)Compared with intravenous or pericardial local use of TxA alone,the combination of TxA and TxA can more effectively reduce systemic inflammatory reaction,reduce troponin-I concentration,and protect cardiac function during heart valve surgery under cardiopulmonary bypass.(3)No vascular embolism or death occurred in the three groups,and there was no difference in the incidence of postoperative acute renal function loss,the rate of second thoracotomy and the rate of mechanical assistance among the three groups(P>0.05),which indicated that the application of tranexamic acid by intracardiac local injection of TxA combined with intravenous small dose of TxA was safe and effective. |
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