婴幼儿体外循环期间氨甲环酸血液浓度研究孙国林1李生德2齐萍2.DOCVIP

婴幼儿体外循环期间氨甲环酸血液浓度研究 孙国林1 李生德2 齐萍2 文仁国1 肖颖彬1 （400038重庆，第三军医大学附属新桥医院心外科1； 266011青岛，青岛儿童医院麻醉科2） 通讯作者 肖颖彬1 xiaoyb@ 摘要 目的：研究婴幼儿法洛四联症（TOF）根治术体外循环(CPB)期间应用氨甲环酸（TA）的血液浓度。方法：5例先天性TOF患儿，体重（7.36±2.08）kg，在开胸前应用TA 100mg/kg，单次静脉缓慢注射（10分钟），CPB开始前再次注射100mg/kg。应用磁共振波谱仪(1H NMR)方法，检测不同时间段TA的血液浓度。结果：CPB开始前(负荷剂量用药后约20分钟)、CPB开始后1小时、手术结束时的液224.61 ±195.28，509.58±181.571，243.95 ± 32.30μg/ml。结论：1H NMR能够检测出TA的血液浓度。本研究的TA用法血药浓度高，大于抑制有高度出血风险可能需要的血液浓度125μg/ml,提示可降低剂量。 关键词 氨甲环酸；婴幼儿；血药浓度；磁共振波谱仪 The study of plasma concentration of tranexamic acid during cardiopulmonary bypass in infants with Tetralogy of Fallot Guolin Suna, Shengde Lib, Ping Qi b,Renguo Wena,Yingbin Xiaoa﹡ . a Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, 183 Xinqiao Street, Chongqing 400037, PR China . b Department of anesthesia ,Qingdao Children Hospital, Qingdao 266071, PR China) ﹡Corresponding author. Tel/fax: +86 23 E-mail address: xiaoyb@ Abstract Objective To study the plasma concentration of tranexamic acid(TA) during cardiopulmonary bypass in infants with Tetralogy of Fallot.Method:5 patients with Tetralogy of Fallot received an initial dose 100 mg/kg of TA given over 10 min followed by an infusion of 100 mg/kg before the initiation of cardiopulmonary bypass(CPB). TA was measured in plasma and urine using with 1H NMR S. Results:Plasma TA concentrations (ug/mL; Mean ± SD) were 224.61 ±195.28 at 20 min after bolus, 509.58±181.571after 60 min on CPB, 243.95 ± 32.30at the end of operation. Conclusions: A 100mg/kg initial dose of TA followed by an infusion of 100mg/kg before the initiation of CPB is sufficient enough to provide an effective plasma concentration 125ug/ml for the bleeding patients with high risk.The dose of TA could be decreased. [Key words】 Tranexamic acid；Cardiopulmonary bypass； Infant; 1H NMR 前言， 氨甲环酸(TA)，对氨甲基环己烷甲酸，分子式C8H15NO2，分子量157，是人工合成抗纤溶药，能竞争性阻抑纤溶酶原在纤维蛋白上的吸附，保护纤维蛋白不被纤溶酶降解，作用机制与6-氨基已酸相似，但作用更强。体外循环（CPB）后继发出血仍是心内直视术后的严重并发症之一。CPB术中使用TA可有效地减少术中和术