Department of Orthopaedic Surgery, University Hospital Case Medical Center, Cleveland, OH, USA.
J Am Acad Orthop Surg. 2010 Mar;18(3):132-8.
Total joint arthroplasty and deformity surgery of the spine can require complex reconstructive procedures accompanied by the potential for major blood loss. In an attempt to minimize the perioperative blood loss associated with these procedures, recent focus has concentrated on the efficacy of pharmacologic agents. Antifibrinolytics such as epsilon-aminocaproic acid, tranexamic acid, and aprotinin have been shown to reduce perioperative blood loss, autologous blood donation, transfusions, and associated costs in cardiac as well as major orthopaedic surgery. These agents reduce perioperative blood loss by inhibition of clot breakdown. Prospective, randomized studies have shown that the use of these agents can be effective in reducing the perioperative blood loss and transfusion requirements in total joint arthroplasty, pediatric scoliosis surgery, and adult reconstructive surgery of the spine. Aprotinin, however, is currently under suspension from use pending further evaluation of a trial. Although concerns exist about increased thrombotic events with the use of these agents, large meta-analyses suggest that antifibrinolytics can be safely and efficaciously employed to decrease perioperative blood loss and transfusion requirements.
全关节置换术和脊柱畸形手术可能需要复杂的重建手术，并伴有大量失血的潜在风险。为了尽量减少这些手术相关的围手术期失血，最近的研究重点集中在药物治疗的效果上。氨甲环酸、氨甲环酸和抑肽酶等抗纤维蛋白溶解剂已被证明可减少心脏和大型骨科手术中的围手术期失血、自体输血、输血和相关费用。这些药物通过抑制血栓分解来减少围手术期失血。前瞻性随机研究表明，这些药物在减少全关节置换术、小儿脊柱侧凸手术和成人脊柱重建手术中的围手术期失血和输血需求方面是有效的。然而，抑肽酶目前已暂停使用，等待进一步评估一项试验。尽管人们对使用这些药物会增加血栓事件的担忧，但大型荟萃分析表明，抗纤维蛋白溶解剂可以安全有效地用于减少围手术期失血和输血需求。
