目的:探究在体外循环(CPB)中应用氨甲环酸(TA)对心脏瓣膜置换患者麻醉术中血液保护作用。方法:选取2018年6月至2019年6月在青海省心脑血管病专科医院行CPB下心脏瓣膜置换术104例患者作为研究对象，随机数字表法分为TA组和对照组，每组各52例，TA组在CPB预充液中添加10 mg/kg TA，对照组在相同情况下给予相同体积生理盐水。比较两组患者围手术期相关指标，手术前后不同时间凝血指标、血红蛋白、血红细胞以及红细胞压积、心肌相关血清学指标。结果:TA组患者术后引流量与异体输血量显著少于对照组患者(n P<0.05)；两组患者手术结束时凝血酶原时间(PT)、凝血酶时间(TT)与部分活化凝血活酶时间(APTT)显著高于手术前与手术后24 h(n P<0.05)，纤维蛋白原水平显著低于手术前与手术后24 h(n P<0.05)，手术结束时与手术后24 h全血血小板计数显著低于手术前，手术后24 h全血血小板计数显著高于手术结束时(n P<0.05)，TA组患者手术结束时上述指标优于对照组(n P0.05)；两组患者手术结束时与手术后24 h血红蛋白、血红细胞以及红细胞压积较手术前显著降低(n P0.05)，TA组患者手术结束时与手术后24 h上述指标低于对照组，差异有统计学意义(n P<0.05)；两组患者手术结束时与手术后24 h时间点肿瘤坏死因子-α(TNF-α)、心肌肌钙蛋白T(cTnT)以及中性粒细胞水平显著高于手术前(n P<0.05)，手术后24 h上述指标水平显著低于手术结束时(n P<0.05)，TA组患者手术结束后与手术后24 h时间点上述指标水平显著低于对照组患者(n P<0.05)。n 结论:心脏瓣膜置换麻醉术中CPB应用TA可以有效抑制纤溶系统作用，血液保护作用显著，能够减少手术完成后输血量，同时保护患者心肌。“,”Objective:To investigate the blood protection effect of tranexamic acid (TA) in anesthesia of heart valve replacement under cardiopulmonary bypass (CPB).Methods:104 patients who underwent heart valve replacement under CPB in Qinghai Cardiovascular and Cerebrovascular Disease Hospital from June 2018 to June 2019 were selected as the research subjects. They were randomly divided into TA group and control group, 52 cases in each group. In TA group, TA (10 mg/kg) was added to CPB priming fluid, and the control group were treated with the same volume of normal saline under the same condition. The perioperative related indexes, coagulation parameters, hemoglobin, red blood cells, hematocrit and cardiac muscle-related serological indexes at different time points before and after surgery were compared between the two groups.Results:The postoperative drainage volume and allogeneic blood transfusion volume in TA group were significantly smaller than those in control group (n P<0.05). At the end of surgery, the prothrombin time (PT), thrombin time (TT) and activated partial thromboplastin time (APTT) in both groups were significantly longer and fibrinogen levels were significantly lower than those before surgery and at 24 h after surgery (n P<0.05). The order of whole blood platelet counts at different time from high to low was as follows: before surgery, at the end of surgery, at 24 h after surgery (n P<0.05). At the end of surgery, the above indexes in TA group were better than those in control group (n P0.05). The hemoglobin, red blood cells and hematocrit in both groups were significantly decreased at the end of surgery and at 24 h after surgery (n P0.05). At the end of surgery and at 24 h after surgery, the above indexes in TA group were lower than those in control group (n P<0.05). At end of surgery and at 24 h after surgery, levels of tumor necrosis factor-α (TNF-α), cardiac troponin (cTnT) and neutrophils in both groups were significantly higher than those before surgery (n P<0.05). Levels of the above-mentioned indexes at 24 h after surgery were significantly lower than those at the end of surgery (n P<0.05). At the end of surgery and at 24 h after surgery, the above indexes in TA group were significantly lower than those in control group (n P<0.05).n Conclusions:In anesthesia of heart valve replacement under CPB, the application of TA can effectively inhibit the action of fibrinolysis system, with obvious blood protection effect. It can also reduce blood transfusion volume after surgery, while protecting the patient's myocardium.