Blood-saving effect of tranexamic acid in pediatric patients undergoing radical correction of tetralogy of Fallot with cardiopulmonary bypass / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the blood-saving effect of tranexamic acid in pediatric patients undergoing radical correction of tetralogy of Fallot with cardiopulmonary bypass (CPB).Methods A total of 56 children of both sexes,aged 11 months-14 yr,with body mass index of 9.8-21.4 kg/m2,of ASA physical status Ⅱ or Ⅲ,with left ventricular ejection fraction ＞50％,scheduled for elective radical correction of tetralogy of Fallot with CPB,were randomly divided into 2 groups using a random number table:tranexamic acid group (TA group,n =30) and normal saline group (NS group,n =26).Anesthesia was induced with iv midazolam,sufentanil,vecuronium and propofol.The children were endotracheally intubated and mechanically ventilated.Anesthesia was maintained with inhalation of 1％-2％ sevoflurane and infusion of propofol,sufentanil and vecuronium.After induction of anesthesia,a loading dose of tranexamic acid l0 mg/kg was intravenously infused over 20 min before skin incision,followed by infusion at a rate of 10 mg · kg-1 · h 1 until the end of surgery in TA group,while the equal volume of normal saline was given instead in NS group.The volume of chest tube drainage at 24 h after surgery and volume of allogeneic red blood cells,fresh frozen plasma,platelet and cryoprecipitate transfused were recorded.The requirement for re-thoracotomy for bleeding,and the incidence of hepatic artery and portal vein thrombosis were also recorded.Results Compared to NS group,the volume of chest tube drainage at 24 h after surgery and volume of allogeneic red blood cells,fresh frozen plasma,platelet and cryoprecipitate transfused were significantly reduced in TA group.No re-thoracotomy was required in TA group,and the rate of re-thoracotomy was 15％ in NS group.No hepatic artery and portal vein thrombosis were detected in group TA.Conclusion Tranexamic acid (loading dose 10 mg/kg,maintenance dose 10 mg· kg-1 · h-1) can provide blood-saving effect and has high security in pediatric patients undergoing radical correction of tetralogy of Fallot with CPB.