目的：探讨预先给予氨甲环酸（TA）对颅底肿瘤手术患者的血液保护效应。方法择期全身麻醉下行开颅颅底肿瘤切除术患者60例，按随机数字表法分为氨甲环酸组（T 组）和对照组（C 组），每组30例。T 组于手术开始前20 min 静脉滴注20 mg·kg－1 TA，C 组给予等容量生理盐水。分别记录2组患者的手术时间、补液量、尿量、术中出血量、自体血回输量、成分输血量及术后24 h 引流量，测定手术切皮前（T0）、切皮后2 h（T1）、术毕（T2）、术后24 h（T3）时血红蛋白（Hb）浓度、红细胞比容（Hct）、血小板计数（Plt）、凝血活酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）含量和 D-二聚体（D-D）浓度。结果与 C 组比较，T 组患者术中出血量、自体血回输量、术后24 h 引流量、输注悬浮红细胞和新鲜冰冻血浆的发生率显著降低（均 P ＜0．05）。与 T0比较，2组患者 T1、T2、T3时 Hb、Hct、Plt 均显著降低（均 P ＜0．05）；与 C 组比较，T 组患者 T1、T2、T3时 Hb、Hct、Plt 显著升高（均P ＜0．05）。2组患者 T0—T3时 PT、APTT 比较差异均无统计学意义（均 P ＞0．05）；与 T0比较，C 组患者 T1、T2、T3时 FIB 降低、D-D 升高（均 P ＜0．05）；与 C 组比较，T 组患者 T1、T2、T3时 FIB 升高、D-D 降低（均 P ＜0．05）。结论颅底肿瘤手术前20 min 给予20 mg·kg－1的氨甲环酸可有效地抑制纤溶系统，减少围术期出血及异体输血的发生率。%Objective To explore the blood-saving effects of tranexamic acid(TA)pretreatment in patients undergoing surgery for skull base tumors.Methods Sixty patients undergoing selec-tive skull base tumor surgery under general anesthesia were randomly assigned to receive intrave-nous drip infusion of either 20 mg·kg-1 TA(group T,n=30)or same volume of saline(group C, n=30)at 20 minutes before operation.The operation time,volume of fluid infusion,urine vol-ume,intraoperative blood loss,volume of autologous blood transfusion,volume of blood compo-nent transfusion,and volume of postoperative 24 h drainage were recorded in both groups.Fur-thermore,hemoglobin(Hb)concentration,hematocrit (Hct),platelet count (Plt),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB)content and D-dimmer (D-D)concentration were measured immediately before skin incision(T0 ),2 hours after skin inci-sion(T1 ),at the end of operation(T2 ),and 24 hours after operation(T3 ).Results Compared with group C,intraoperative blood loss,volume of autologous blood transfusion,volume of postopera-tive 24 h drainage,and requirement for transfusion of erythrocyte suspension and fresh frozen plasma significantly decreased in group T(P <0.05).Compared with T0 ,the Hb,Hct and Plt sig-nificantly decreased at T1 ,T2 and T3 in both groups(P <0.05).Compared with group C,the Hb, Hct and Plt significantly increased in group T at T1 ,T2 and T3 (P <0.05).There were no differ-ences in PT and APTT between the two groups at T0-T3 (P >0.05).Compared with T0 ,the FIB decreased but the D-D increased at T1 ,T2 and T3 in group C(P <0.05).Compared with group C, the FIB increased but D-D decreased in group T at T1 ,T2 and T3 (P <0.05).Conclusion Treat-ment with 20 mg·kg-1 TA at 20 minutes before operation can effectively inhibit fibrinolysis and reduce the incidence of perioperative bleeding and allogeneic blood transfusion.
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