Athanasiadis Theodore, Beule Achim G, Wormald Peter J
Department of Otorhinolaryngology, Head and Neck Surgery, The Queen Elizabeth Hospital, University of Adelaide, Australia.
Am J Rhinol. 2007 Nov-Dec;21(6):737-42. doi: 10.2500/ajr.2007.21.3097.
Bleeding in endoscopic sinus surgery (ESS) may increase the risk of intraoperative complications and is associated with poorer outcomes Antifibrinolytic agents have been shown to reduce bleeding if administered systemically. The aim of this study was to determine the effect of topical epsilon-aminocaproic acid (EACA) and tranexamic acid (TA) on bleeding in the surgical field during ESS.
A prospective blind randomized controlled trial was performed. Thirty patients undergoing ESS were randomized to receive either 2.5 g of EACA, 100 mg of TA, or 1 g of TA while the contralateral side received saline. The solution was applied as a spray at the conclusion of operating on each side. Bleeding was documented using standardized videoendoscopy and grading scales.
EACA did not show a significant effect on intraoperative bleeding. TA at 100 mg showed a clinically significant improvement in the surgical field at 2, 4, and 6 minutes after application. The mean for 2 minutes was TA, 1.6 +/- 1.08, and control, 2.2 +/- 1.3; at 4 minutes was TA, 1.25 +/- 1.2, and control, 1.7 +/- 1.2,; and at 6 minutes was TA, 0.75 +/- 1.2, and control, 1.3 +/- 1.4 (p < 0.05). TA at 1 g also approached significance at all time points. Combined results from the two TA groups showed a significant improvement in the surgical field at 2, 4, 6, and 8 minutes after application. TA was regarded by the blinded surgeon as more effective than saline in 80% of cases. No adverse effects were encountered after topical application of either drug.
Topical application of TA is effective in achieving hemostasis and improving the surgical field. In contrast to EACA, TA is a valuable tool in ESS that merits additional evaluation.
鼻内镜鼻窦手术（ESS）中的出血可能会增加术中并发症的风险，并与较差的手术结果相关。抗纤溶药物经全身给药已显示可减少出血。本研究的目的是确定局部应用氨甲环酸（EACA）和氨甲环酸（TA）对ESS手术视野出血的影响。
进行了一项前瞻性双盲随机对照试验。30例行ESS的患者被随机分为接受2.5g EACA、100mg TA或1g TA，而对侧接受生理盐水。在每侧手术结束时将溶液作为喷雾剂应用。使用标准化视频内镜和分级量表记录出血情况。
EACA对术中出血未显示出显著效果。100mg的TA在应用后2、4和6分钟时手术视野有临床显著改善。2分钟时，TA组平均为1.6±1.08，对照组为2.2±1.3；4分钟时，TA组为1.25±1.2，对照组为1.7±1.2；6分钟时，TA组为0.75±1.2，对照组为1.3±1.4（p<0.05）。1g的TA在所有时间点也接近显著水平。两个TA组的综合结果显示，应用后2、4、6和8分钟时手术视野有显著改善。80%的病例中，盲法外科医生认为TA比生理盐水更有效。局部应用两种药物后均未出现不良反应。
局部应用TA在实现止血和改善手术视野方面是有效的。与EACA不同，TA是ESS中一种有价值的工具，值得进一步评估。
