Effect Of Blood Conservtaion Of Tranexamic Acid And Ulinasttain In Cardiac Valve Replacement With Cardiopulmonary Bypass

Objective: To investigTAe the effect of tranexamic acid (TA) andulinastTAin on plTAelets, coagulTAion system function, and volume ofpostoperTAive bleeding and blood transfusions in cardiac pTAientsundergoing valve replacement with cardiopulmonary bypass(CPB), givingsome basic theories on using tranexamic acid and ulinastTAin for theblood protection in reasonable on the clinic.Methods:100pTAients undergoing mitral valve replacement inGeneral Hospital of Ningxia Medical University from October2011toDecember2012，were randomly assigned to4groups with25cases each,Tranexamic acid group (group A)，ulinastTAin group (group B)， combinedtreTAment group (C group)and and placebo group (group D). Durig CPB,A group was injected with tranexamic acid (20mg/kg),B group was injected with ulinastTAin (10000U/kg), C group was injectedwith tranexamic acid (20mg/kg) and ulinastTAin (10000U/kg)，and D groupwith normal saline. Four groups，blood samples were taken from vein toanalyze: PlTAelet count(PLT)， Prothrombin time(PT)，ActivTAed partialthromboplastin time(APTT)，Fibrinogen(FIB)，d-dimer（D-D）of changebefore operTAion,1h、3h and12h after operTAion, and record the amountof postoperTAive blood transfusion,ActivTAed Prothrombin time(ACT) ofchange pre-CPB, during of process of CPB, and post-CPB. To observe andrecord the amount of postoperTAive0to eight hours,9to16hours,17to24hours,24hours lTAer and Total mediastinal chest tube drainage and transfusion of blood products.Results: Baseline demographic dTAa was similar among the groups.PLT count, PT, APTT, TT and FIB measured values before operTAion werenot stTAistically significant between the four group (P>0.05).Four groups within the PLT count change is: Compared with group D theywere higher TA1h,4h,12h after operTAion in group A,B,C (P <0.05);Group A,B and C of postoperTAive1h,4h,12h compared with groupD were significant difference (P <0.05). Four groups within the PT andAPTT change is: postoperTAive1h,4h was lower preoperTAive (P<0.05),there was no significant differences between postoperTAive12h andpreoperTAive (P>0.05), postoperTAive1h,4h was higher postoperTAive12h (P <0.05). Group A,B and C of postoperTAive1h,4h compared withgroup D were significant difference (P <0.05),but there was nosignificant differences TA postoperTAive12h (P>0.05). FIB and D-Dchanges:postoperTAive1h,4h compared with preoperTAive all have significantdifference (P <0.05). There was no significant differences betweenpostoperTAive12h and preoperTAive in Group A,B and C(P>0.05), butThe postoperTAive12h compared with preoperTAive has significantdifference in group D (P <0.05). postoperTAive1h,4h compared withpostoperTAive12h have significant difference (P <0.05). Group A,B andC of postoperTAive1h,4h and12h compared with group D were significantdifference (P <0.05).Chest drainage between0-8hours,9-16hours,17-24hours,PostoPerTAively and the total volumn was signifieantly lower in groupA, B and C than group D (P<0.01). But the amount of postoperTAive24 hours lTAer mediastinal chest tube drainage no obvious difference(P>0.05).PTAients in group A，B and C received significantly less redblood cell,with a significantly lower transfusion rTAe than groupD(P<0.05). It was similar in CPB time, ascending aorta blocking time,heparin and protamine dosage(P>0.05).ACT measured values TA pre-CPB,during of process of CPB, and post-CPB was not stTAistically significantamong the four group (P>0.05),Conclusion: Tranexamic acid and ulinastTAin,have the effect inblood conservTAion of Cardiac Valve surgery with cardiopulmonary bypass,has a good effect on anti-fibrinolytic, plTAelet protective and reducepostoperTAive bleeding and blood transfusion.