两剂氨甲环酸减少复杂脊柱手术中的输血：一项前瞻性随机研究。
Two Doses of Tranexamic Acid Reduce Blood Transfusion in Complex Spine Surgery: A Prospective Randomized Study.
作者信息
Raksakietisak Manee, Sathitkarnmanee Benjabhorn, Srisaen Peeranat, Duangrat Tithiganya, Chinachoti Thitima, Rushatamukayanunt Pranee, Sakulpacharoen Nuchanat
机构信息
From the Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
出版信息
Spine (Phila Pa 1976). 2015 Dec;40(24):E1257-63. doi: 10.1097/BRS.0000000000001063.
STUDY DESIGN
Prospective, double-blinded, randomized controlled study.
OBJECTIVE
To determine whether the use of 2 doses of tranexamic acid (TXA) can reduce perioperative blood loss and blood transfusions in low-risk adult patients undergoing complex laminectomy.
SUMMARY OF BACKGROUND DATA
Complex laminectomy (multilevel laminectomy or laminectomy and instrumentation) is a procedure with a medium risk of blood loss, which may require allogeneic blood transfusion. Previous studies of TXA showed its inconsistent effectiveness in reducing blood loss during spine surgery. The negative results may stem from ineffective use of a single dose of TXA during long and complex operations.
METHODS
80 adult (18-65 yr old) patients in Siriraj Hospital, Mahidol University, Thailand were enrolled and allocated into 2 groups (40 patients in each group) by computer-generated randomization. Patients with history of thromboembolic diseases were excluded. Anesthesiologists in charge and patients were blinded. Group I received 0.9% NaCl (NSS) or placebo and group II received 2 doses (15 mg/kg) of TXA. The first dose was administered before anesthesia induction and the second dose, after 3 hours. The assessed outcomes were the amount of perioperative blood loss and the incidence of blood transfusions.
RESULTS
78 patients were analyzed (1 patient in each group was excluded) with 39 patients randomized to each group. There were no differences in patient demographics and pre and postoperative hematocrit levels. The total blood loss in the control group (NSS) was higher [900 (160, 4150) mL] than in the TXA group [600 (200, 4750) mL]. Patients in the control group received more crystalloid, colloid, and packed red blood cell transfusions. Within 24 hours, we observed a 64.6% reduction of blood transfusions (43.5% vs.15.4%, P = 0.006). No serious thromboembolic complications occurred.
CONCLUSION
2 effective doses (15 mg/kg) of TXA can reduce blood loss and transfusions in low-risk adults undergoing complex spine surgery.
LEVEL OF EVIDENCE
研究设计
前瞻性、双盲、随机对照研究。
目的
确定使用两剂氨甲环酸（TXA）是否可减少接受复杂椎板切除术的低风险成年患者的围手术期失血和输血情况。
背景数据总结
复杂椎板切除术（多节段椎板切除术或椎板切除术及器械植入）是一种具有中度失血风险的手术，可能需要异体输血。既往对TXA的研究显示其在减少脊柱手术期间失血方面的效果不一致。负面结果可能源于在长时间复杂手术中单一剂量TXA使用无效。
方法
泰国玛希隆大学诗里拉吉医院的80名成年（18 - 65岁）患者入组，并通过计算机生成随机化分为2组（每组40例患者）。排除有血栓栓塞性疾病病史的患者。负责的麻醉医生和患者均不知情。第一组接受0.9%氯化钠（NSS）或安慰剂，第二组接受两剂（15 mg/kg）TXA。第一剂在麻醉诱导前给药，第二剂在3小时后给药。评估的结果是围手术期失血量和输血发生率。
结果
分析了78例患者（每组排除1例患者），每组随机分配39例患者。患者人口统计学特征以及术前和术后血细胞比容水平无差异。对照组（NSS）的总失血量[900（160，41五百）毫升]高于TXA组[600（200，47五百）毫升]。对照组患者接受了更多的晶体液、胶体液和浓缩红细胞输血。在24小时内，我们观察到输血减少了64.6%（43.5%对15.4%，P = 0.006）。未发生严重血栓栓塞并发症。
结论
两剂有效剂量（15 mg/kg）的TXA可减少接受复杂脊柱手术的低风险成年人的失血和输血情况。
证据级别
1级
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