本文選題：心臟手術(shù) + 體外循環(huán)��； 參考：《北京協(xié)和醫(yī)學(xué)院》2015年碩士論文

【摘要】：目的氨甲環(huán)酸是一種人工合成的抗纖溶藥物,預(yù)防應(yīng)用具有減少體外循環(huán)心臟手術(shù)后出血和異體輸血的作用。但是氨甲環(huán)酸在體外循環(huán)心臟手術(shù)最佳用藥劑量尚未確定。本研究目的是比較三種不同劑量的氨甲環(huán)酸用于體外循環(huán)心臟手術(shù)減少出血和異體輸血的效果。方法本研究為前瞻性、隨機(jī)、雙盲試驗(yàn)。選擇從2012年9月至2014年9月,年齡18歲到75歲之間在阜外醫(yī)院行擇期體外循環(huán)心臟手術(shù)的患者,共955例,包括冠狀動(dòng)脈旁路移植術(shù)、心臟瓣膜成形或置換、非紫紺型先天性心臟病、心房粘液瘤和肥厚梗阻性心肌病。所有患者隨機(jī)分成三組,手術(shù)開始時(shí)給予氨甲環(huán)酸。小劑量組在15分鐘內(nèi)給予10mg/kg的負(fù)荷量,隨后給予2mg/kg/h的維持量,體外循環(huán)預(yù)充液中加入10mg/kg的預(yù)充量。中劑量組在15分鐘內(nèi)給予20mg/kg的負(fù)荷量,隨后給予4mg/kg/h的維持量,體外循環(huán)預(yù)充液中加入20mg/kg的預(yù)充量。大劑量組在15分鐘內(nèi)給予30mg/kg的負(fù)荷量,隨后給予6mg/kg/h的維持量,體外循環(huán)預(yù)充液中加入30mg/kg的預(yù)充量。記錄術(shù)后6小時(shí)和24小時(shí)內(nèi)的胸管引流液量,記錄術(shù)后7天內(nèi)所有使用異體血的病例數(shù)和輸血量,記錄并發(fā)癥的發(fā)生率。結(jié)果使用大、中、小劑量氨甲環(huán)酸的三組之間術(shù)后6小時(shí)和24小時(shí)的胸管引流液量比較無(wú)統(tǒng)計(jì)學(xué)意義,三組之間需要輸異體血的病例數(shù),以及輸血的患者所使用的異體血用量也沒有顯著差異。各組間術(shù)后7天內(nèi)并發(fā)癥的發(fā)生率無(wú)顯著差異。結(jié)論使用小劑量、中劑量和大劑量氨甲環(huán)酸對(duì)減少體外循環(huán)心臟手術(shù)術(shù)后胸液量、輸血量和輸血率的作用效果相同。
[Abstract]:Objective Ammonocycline is a synthetic antifibrinolytic drug, which can reduce bleeding and allogeneic blood transfusion after cardiopulmonary bypass (CPB). However, the optimal dosage of carbamate in cardiopulmonary bypass heart surgery has not been determined. The purpose of this study was to compare the effects of three different doses of carbamate on reducing bleeding and allogeneic blood transfusion during cardiopulmonary bypass (CPB). Methods the study was prospective, randomized and double blind. From September 2012 to September 2014, a total of 955 patients, aged 18 to 75 years, underwent elective cardiopulmonary bypass heart surgery in Fuwei Hospital, including coronary artery bypass grafting, heart valve plasty or replacement. Cyanotic congenital heart disease, atrial myxoma and hypertrophic obstructive cardiomyopathy. All patients were randomly divided into three groups. In the low dose group, the loading of 10mg/kg was given within 15 minutes, then the maintenance of 2mg/kg/h was given, and the precharge of 10mg/kg was added to the cardiopulmonary bypass (CPB). In the middle dose group, the loading of 20mg/kg was given within 15 minutes, then the maintenance of 4mg/kg/h, and the precharge of 20mg/kg was added to the cardiopulmonary bypass (CPB). In the high dose group, the load of 30mg/kg was given within 15 minutes, then the maintenance of 6mg/kg/h was given, and the precharge of 30mg/kg was added to the cardiopulmonary bypass (CPB). The amount of drainage fluid was recorded at 6 hours and 24 hours after operation, the number of cases using allogeneic blood and the amount of blood transfusion were recorded 7 days after operation, and the incidence of complications was recorded. Results there was no significant difference in the amount of thoracic tube drainage between the three groups using large, medium and small doses of carbamoic acid at 6 hours and 24 hours after operation, and the number of cases with allogeneic blood transfusion between the three groups was not statistically significant. There was also no significant difference in the amount of allogeneic blood used in patients with blood transfusions. There was no significant difference in the incidence of complications within 7 days after operation among the groups. Conclusion the effects of low, medium and high doses of carbamate on reducing the amount of pleural effusion, blood transfusion and blood transfusion rate after cardiopulmonary bypass heart surgery are the same.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R614

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