Wong Jean, El Beheiry Hossam, Rampersaud Yoga Raja, Lewis Stephen, Ahn Henry, De Silva Yoshani, Abrishami Amir, Baig Naseer, McBroom Robert J, Chung Frances
Department of Anesthesia, Toronto Western Hospital, MC 2-434, 399 Bathurst Street, Toronto, Ontario, Canada M5T2S8.
Anesth Analg. 2008 Nov;107(5):1479-86. doi: 10.1213/ane.0b013e3181831e44.
Spinal reconstructive surgery in adults can be associated with significant blood loss, often requiring allogeneic blood transfusion. The objective of this randomized, prospective, double-blind, multicenter study was to evaluate the efficacy of tranexamic acid (TXA) in reducing perioperative blood loss and transfusion in adult patients having elective posterior thoracic/lumbar instrumented spinal fusion surgery.
One hundred fifty-one adult patients were randomized to receive either a bolus of 10 mg/kg IV of TXA after induction followed by a maintenance infusion of 1 mg/kg/hr of TXA, or an equivalent volume of placebo (normal saline). The primary outcome was the total perioperative estimated and calculated blood loss intraoperatively and 24 h postoperatively. Secondary outcomes were incidence of allogeneic blood exposure, and duration of hospital stay.
Four patients were withdrawn for identifiable surgical bleeding, therefore 147 patients were included in the analysis. The total estimated and calculated perioperative blood loss was approximately 25% and 30% lower in patients given TXA versus placebo (1592 +/- 1315 mL vs 2138 +/- 1607 mL, P = 0.026; 3079 +/- 2558 vs 4363 +/- 3030, P = 0.017), respectively. There was no difference in the amounts of blood products transfused, and length of stay between the two groups. TXA, surgical duration, and number of vertebrae fused were independent factors related to perioperative blood loss. Predictors for the need for allogeneic red blood cell transfusion were ASA classification, surgical duration and number of levels fused.
TXA significantly reduced the estimated and calculated total amount of perioperative blood loss in adult patients having elective posterior thoracic/lumbar instrumented spinal fusion surgery.
成人脊柱重建手术可能伴有大量失血，常需输注异体血。这项随机、前瞻性、双盲、多中心研究的目的是评估氨甲环酸（TXA）在减少择期胸段/腰段后路器械辅助脊柱融合手术成年患者围手术期失血及输血方面的疗效。
151例成年患者被随机分为两组，一组在诱导后静脉注射10mg/kg的TXA推注剂量，随后以1mg/kg/小时的速度持续输注TXA；另一组输注等量的安慰剂（生理盐水）。主要结局指标是术中及术后24小时围手术期估计和计算的总失血量。次要结局指标是异体血暴露发生率和住院时间。
4例患者因明确的手术出血而退出，因此147例患者纳入分析。接受TXA治疗的患者围手术期估计和计算的总失血量分别比接受安慰剂治疗的患者低约25%和30%（1592±1315ml对2138±1607ml，P = 0.026；3079±2558对4363±3030，P = 0.017）。两组之间输注的血液制品量和住院时间没有差异。TXA、手术时间和融合的椎体数量是与围手术期失血相关的独立因素。异体红细胞输血需求的预测因素是美国麻醉医师协会（ASA）分级、手术时间和融合节段数。
TXA显著减少了择期胸段/腰段后路器械辅助脊柱融合手术成年患者围手术期估计和计算的总失血量。
