小儿室间隔缺损修补术中乌司他丁及氨甲环酸联用的效果及临床意义

摘要

目的：观察小儿室间隔缺损修补术中联合应用乌司他丁及氨甲环酸的临床效果，探讨其临床意义。方法选取室间隔缺损患儿200例，按照随机数字法分为A组、B组、C组及对照组，每组各50例。择期行室间隔缺损修补术，四组均于麻醉诱导后给药：A组静脉注射乌司他丁10000 U／kg，B组静脉注射氨甲环酸注射液20 mg／kg，C组静脉注射氨甲环酸注射液20 mg／kg及乌司他丁10000 U／kg，对照组静脉注射同等体积生理盐水。记录术中心包引流量及冰冻血浆输注量。手术前及手术结束12 h后自中心静脉导管取血，检测血清炎症指标（TNF-α、IL-6、IL-10）及凝血指标（中性粒弹性蛋白酶、PT、APTT）。结果 A、B、C组术中心包引流量及冰冻血浆输注量均少于对照组，且C组少于A、B组（P均＜0．05）。 A、B、C组血清TNF-α及IL-6水平均低于对照组，且C组低于A、B组；A、B、C组血清IL-10水平高于对照组，且C组高于A、B组；A、B、C组血清弹性蛋白酶水平、PT、APTT均低于对照组，且C组低于A、B组（P均＜0．05）。结论小儿室间隔缺损修补术中联合应用乌司他丁及氨甲苯酸具有较好的止血作用，可减少术中心包引流量及输血量，可能与促进凝血功能及抑制炎症反应有关。%Objective To explore the effect of ulinastatin and tranexamic acid on inflammatory and coagulation indexes in children undergoing ventricular septal defect repair .Methods A total of 200 children diagnosed with ventricular septal defect were divided into four groups, 50 cases in each group: ulinastatin group (group A), tranexamic acid group (group B) , combination group ( group C) and the control group .The volume of drainage from pericardium and frozen plasma infusion volume during the operation were recorded .We took the blood from the central venous catheter before and 12 hours after oper-ation to detect the serum inflammatory indexes , including tumor necrosis factor-α( TNF-α) , interleukin-6 ( IL-6) and inter-leukin-10 (IL-10), and coagulation indexes, including neutral grain of elastase, prothrombin time (PT) and activated partial thromboplastin time ( APTT) .Results The volume of drainage from pericardium and frozen plasma infusion volume of the groups A, B and C were less than that of the control group , and the combination group was less than the other groups ( all P<0.05).The serum levels of TNF-αand IL-6 in the groups A, B and C were lower than that of the control group , and group C was lower than the other two groups;the serum level of IL-10 in the groups A, B and C were higher than that of the control group, and group C was higher than the other two groups;the serum levels of elastase , PT and APTT in the groups A, B and C were lower than that of the control group , and group C was lower than the other two groups ( all P<0.05) .Conclusion The ulinastatin and aminomethylbenzoic acid have hemostatic and anti-inflammatory effect in children undergoing ventricular septal defect repair , which can reduce the volume of drainage from pericardium and frozen plasma infusion volume during the operation, and it may be related with the promotion of coagulation and inhibition of inflammatory reaction .