氨甲环酸对经尿道前列腺电切术失血量的影响

Effect of tranexamic acid on perioperative blood loss during transurethral resection of prostate

关键词:  氨甲环酸  经尿道前列腺电切术  出血

Key words:  [Key words]　tranexamic acid  TURP  haemorrhage

摘要:

〗[摘要]　目的　探讨人工合成的抗纤溶药物氨甲环酸对接受经尿道前列腺电切术的患者失血量的影响及其安全性。 　方法　2012 年1 月—2013 年2月行经尿道前列腺电切术的60 例患者，随机双盲分为氨甲环酸组（T组）和空白对照组（C组），每组30例。T组在麻醉诱导后将氨甲环酸注射液1 g/200 mL（以20~40滴/min的速度）静滴完毕。C组给予等量生理盐水同样的速度静滴完毕。比较两组术中、术后 4 h、术后24 h的失血量，比较两组术前、术后4 h凝血功能（凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、纤维蛋白原）的变化，观察术后7 d内是否有下肢深静脉血栓或肺栓塞等并发症的发生。　结果　T组术中失血量(102.0±11.4) mL及术后4 h的失血量（61.9±6.1）mL明显少于C组术中失血量（303.6±24.8）mL及术后4 h的失血量（84.8±15.2）mL，差异有显著性意义（P<0.05）。而两组术后24 h失血量比较差异无显著性意义。两组患者凝血指标的比较差异无显著性意义且两组患者均未发现下肢深静脉血栓或肺栓塞等并发症的发生。　结论　氨甲环酸可以明显降低经尿道前列腺电切术术中及术后4 h的失血量，且未增加血栓形成的风险。

Abstract:

[Abstract]　Objective　To determine the effect of tranexamic acid on perioperative blood loss in patients who underwent transurethral resection of the prostate (TURP), as well as its safety.　Methods　A double blind randomized control trial was conducted from January 2012 to February 2013. In this trial, 30 patients of the tranexamic acid group (T group), between age of 55-85 years, underwent TURP and received 1 g of tranexamic acid in 200 mL normal saline after induction of anesthesia and 30 patients of the control group (C group) received a placebo (normal saline only). The medicine dripping speed ranged 20-40 drops/minute. The amount of blood loss was measured during the operation and at 4 h and 24 h postoperatively and the difference between the two groups was analyzed. Coagulation profiles, including prothrombin time，thrombin time and fibrinogen level, were measured preoperatively and 4 h postoperatively. Any signs of thromboembolic event especially in the lower limbs or within 7 days were noted.　Results　The blood losses during operation and 4 h postoperation were (102.0±11.4) mL and (61.9±6.1) mL, respectively in the T group and (303.6±24.8) mL and (84.8±15.2) mL, respectively in the C group. The values were significantly lower in the T group compared to those in the C group (P<0.05). However, there was no significant difference at 24 h postoperative blood loss between the groups. The coagulation profiles in the two groups were statistically not relevant. There was no evidence of deep vein thrombosis in the lower limbs or in both groups. 　Conclusion　Tranexamic acid can reduce intraoperative blood loss during TURP without increasing the risk of thrombosis.