Tehran University Medical Journal
مجله دانشکده پزشکی، دانشگاه علوم پزشکی تهران
Tehran Univ Med J
Medical Sciences
http://tumj.tums.ac.ir
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1683-1764
1735-7322
10.18869/acadpub.tumj
000
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fa
jalali
1391
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gregorian
2012
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تاثیر تجویز ترانکسامیک اسید بر خونریزی بعد از اعمال جراحی پیوند عروق کرونر
The effects of tranexamic acid on postoperative bleeding in coronary artery bypass graft surgery
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<p class="MsoNormal" dir="rtl" style="text-align: justify direction: rtl unicode-bidi: embed"><strong><span style="font-size: 10pt">زمینه و هدف:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">تجویز پیرامون عمل ترانکسامیک اسید خونریزی و ترانسفوزیون را پس از اعمال جراحی قلبی کاهش میدهد، ولی نتایج در شرایط مختلف متفاوت بوده و از طرفی زمان مناسب تجویز دارو برای حصول به نتیجه مطلوبتر مشخص نیست. هدف از مطالعه حاضر تعیین تاثیر ترانکسامیک اسید در کاهش درناژ و نیاز به ترانسفوزیون خون در بیماران کاندیدای عمل جراحی اولیه پیوند عروق کرونر و همچنین تعیین زمان مناسب تجویز این دارو میباشد.</span><span style="font-size: 9pt"> </span></p>
<p class="MsoNormal" dir="rtl" style="text-align: justify direction: rtl unicode-bidi: embed"><strong><span style="font-size: 10pt">روش بررسی:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">در یک کارآزمایی بالینی آیندهنگر دوسوکور 150 بیمار کاندیدای عمل جراحی اولیه پیوند عروق کرونر مطالعه شدند. بیماران بهصورت تصادفی به سه گروه </span><span style="font-size: 7pt">B</span><span style="font-size: 10pt">، </span><span style="font-size: 8pt">mg/kg</span><span style="font-size: 10pt">10 ترانکسامیک اسید قبل، گروه </span><span style="font-size: 7pt">A</span><span style="font-size: 10pt">، همان مقدار دارو پس از بایپس قلبی ریوی و گروه </span><span style="font-size: 7pt">C</span><span style="font-size: 10pt"> نرمال سالین تقسیم شدند. میزان نیاز به خون آلوژنیک و میزان درناژ لولههای سینهای ثبت گردید.<strong> </strong></span></p>
<p class="MsoNormal" dir="rtl" style="text-align: justify direction: rtl unicode-bidi: embed"><strong><span style="font-size: 10pt">یافتهها:</span></strong><span style="font-size: 10pt"> </span><span style="font-size: 10pt">گروه پلاسبو (گروه </span><span style="font-size: 7pt">C</span><span style="font-size: 10pt">) درناژ خونی بیشتری در طول 12 ساعت اول بعد از عمل داشت (288</span><span lang="FA" style="font-size: 8pt">±</span><span style="font-size: 10pt">501 در مقابل 184</span><span lang="FA" style="font-size: 8pt">±</span><span style="font-size: 10pt">395 در گروه </span><span style="font-size: 7pt">B</span><span style="font-size: 10pt"> <span lang="FA">و 181</span></span><span lang="FA" style="font-size: 8pt">±</span><span style="font-size: 10pt">353 میلیلیتر در گروه </span><span style="font-size: 7pt">A</span><span style="font-size: 10pt">، 004/0</span><span style="font-size: 7pt">P=</span><span style="font-size: 10pt">). گروه پلاسبو همچنین درناژ بعد از عمل بالاتری داشت (347</span><span lang="FA" style="font-size: 8pt">±</span><span style="font-size: 10pt">800 در مقابل 276</span><span lang="FA" style="font-size: 8pt">±</span><span style="font-size: 10pt">614 در گروه </span><span style="font-size: 7pt">B</span><span style="font-size: 10pt"> و 228</span><span lang="FA" style="font-size: 8pt">±</span><span style="font-size: 10pt">577 میلیلیتر در گروه </span><span style="font-size: 7pt">A</span><span style="font-size: 10pt">، 001/0</span><span style="font-size: 7pt">P=</span><span style="font-size: 10pt">). میزان نیاز به خون آلوژنیک نیز در گروه کنترل نسبت به دو گروه دیگر بیشتر بود (001/0</span><span style="font-size: 7pt">P=</span><span style="font-size: 10pt">).</span><strong><em><span style="font-size: 10pt"> </span></em></strong></p>
<p class="MsoNormal" dir="rtl" style="text-align: justify direction: rtl unicode-bidi: embed"><strong><span style="font-size: 10pt">نتیجهگیری:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">در بیماران انتخابی کاندیدای عمل جراحی پیوند اولیه عروق کرونر، تجویز تکدوز ترانکسامیک اسید قبل و بعد از بایپس قلبی ریوی تاثیر یکسانی دارد.</span></p>
<p style="text-align: justify"><strong>Background</strong>: Perioperative administration of tranexamic acid (TA), decreases bleeding and the need for transfusion after cardiac procedures. Hence, the results may vary in different clinical settings and the most appropriate timing to get the best results is unclear. The primary objectives of the present study were to determine the efficacy of TA in decreasing chest tube drainage, the need for perioperative allogeneic transfusions and the best timing for TA administration following primary, elective, coronary artery bypass grafting (CABG) in patients with a low baseline risk of postoperative bleeding.</p>
<p style="text-align: justify"><strong>Methods</strong>: In this double-blind, prospective, placebo-controlled clinical trial in Seiedoshohada Hospital during 2011-2012, we evaluated 150 patients scheduled for elective, primary coronary revascularization. They were randomly divided into three groups. Group B received tranexamic 10 mg/kg prior to, Group A received tranexamic acid 10 mg/kg after cardiopulmonary bypass and group C received an equivalent volume of saline solution. Blood requirement and postoperative chest tube drainage were recorded.</p>
<p style="text-align: justify"><strong>Results</strong>: The placebo group (group C) had a greater postoperative blood loss 12 h after surgery (501±288 vs. 395±184 in group B and 353±181 mL in group A, P=0.004). The placebo group also had greater postoperative total blood loss (800±347 vs. 614±276 in group B and 577±228 mL in group A, P=0.001). There was a significant increase in allogeneic blood requirement in the placebo group (P=0.001).</p>
<p style="text-align: justify"><strong>Conclusion</strong>: For elective, first time coronary artery bypass surgery, a single dose of tranexamic acid before or after cardiopulmonary bypass is equally effective.</p>
ترانکسامیک اسید,بایپس قلبی ریوی,خونریزی بعد از عمل,پیوند عروق کرونر
Bleeding,cardiopulmonary bypass,coronary artery bypass grafting,postoperative hemorrhage,tranexamic acid
176
182
http://tumj.tums.ac.ir/browse.php?a_code=A-10-404-5&slc_lang=fa&sid=1
Hassani
Ebrahim
ابراهیم
حسنی