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目的观察6-氨基己酸(EACA)对儿童体外循环(CPB)时纤溶系统及围术期出血量的影响。方法 40例先心病患儿随机均分为用药组(EACA组)和对照组(C组)。分别于切皮前即刻(T0)、CPB30min(T1)、鱼精蛋白中和肝素后10min(T2)、术后2h(T3)和术后24h(T4)时采集静脉血,测定血浆组织型纤溶酶原激活物(t-PA)、纤溶酶原激活物抑制剂(PAI)、纤溶酶(Plm)活性及D-二聚体(D-di-mer)浓度,同时记录术后24h内出血量。结果与T0比较,C组血浆t-PA、t-PA/PAI活性在T1-3、Plm活性在T2-3、D-dimer浓度在Tl-4时升高(P<0.05或0.01)。与C组比较EACA组血浆t-PA活性、t-PA/PAI在T1-3、Plm活性在T1-4、D-dimer浓度在T1-4时降低(P<0.05或0.01)。术后24h出血量EACA组少于C组(P<0.05)。结论 EACA可有效地抑制儿童CPB期间纤溶系统的激活,明显减少术后失血量。
Objective To observe the effect of 6-aminocaproic acid (EACA) on fibrinolytic system and perioperative blood loss in children with cardiopulmonary bypass (CPB). Methods Forty patients with congenital heart disease were randomly divided into medication group (EACA group) and control group (C group). Venous blood samples were collected immediately before skin incision (T0), CPB30min (T1), protamine and heparin 10min (T2), 2h after operation (T3) and 24h after operation (T4) (T-PA), plasminogen activator inhibitor (PAI), plasmin (Plm) activity and D-di-mer concentration were measured at the same time Internal bleeding. Results Compared with T0, plasma t-PA and t-PA / PAI activities in group C were significantly increased at T1-3 and Pl-2 levels at T2-T and D-dimer at Tl-4 (P <0.05 or 0.01). Compared with group C, the plasma t-PA activity of EACA group and the activity of t-PA / PAI at T1-3 and Plm decreased at T1-4 and D-dimer concentrations at T1-4 (P <0.05 or 0.01). The amount of hemorrhage 24h after operation was lower in EACA group than in C group (P <0.05). Conclusion EACA can effectively inhibit the activation of fibrinolytic system in children during CPB and significantly reduce the amount of postoperative blood loss.