Das Anjan, Chattopadhyay Surajit, Mandal Debabrata, Chhaule Subinay, Mitra Tapobrata, Mukherjee Anindya, Mandal Subrata Kumar, Chattopadhyay Sandip
Department of Anaesthesiology, College of Medicine and Sagore Dutta Hospital, Berhampore, West Bengal, India.
Department of Oral and Maxillofacial Surgery, Dr. R. Ahmed Dental College, Berhampore, West Bengal, India.
Anesth Essays Res. 2015 Sep-Dec;9(3):384-90. doi: 10.4103/0259-1162.161806.
Head and neck cancer (HNC) surgery is associated with high intraoperative blood loss which may require urgent blood transfusion. Many strategies have been recommended to decrease the need for allogenic transfusion. Use of perioperative tranexamic acid (TA) has a promising role.
This study was to evaluate the effectiveness of single preoperative bolus dose of TA on blood loss prevention and red blood cell transfusion in patients undergoing HNC surgery.
A prospective, double-blind, and randomized controlled study.
From 2007 July to 2010 January; 80 patients, aged (35-55), of American Society of Anesthesiologists II-III scheduled for unilateral HNC surgeries were randomly received either TA (Group T) in a dose of 20 mg/kg diluted to 25 cc with normal saline or an equivalent volume of normal saline (Group C) in a tertiary care hospital. Hemoglobin (Hb) concentration, platelet count, packed cell volume, fibrinogen level, D-dimer level were measured pre- and post-operatively.
Saline (C) Group required more blood, colloid, crystalloid for blood loss. In Group T, 32 patients did not require transfusion of any blood products compared to five patients in Group C (P < 0.0001) and only eight units of blood was transfused in Group T, whereas a total of 42 units of blood was transfused in Group C. Even after numerous transfusions, Hb% after 6 h and 24 h in Group C were significantly low in comparison with Group T (P < 0.05).
Thus, TA significantly reduces blood loss and chances of colloid, blood, and crystalloid transfusion caused by HNC surgery.
头颈癌（HNC）手术术中失血量较大，可能需要紧急输血。已推荐多种策略以减少异体输血的需求。围手术期使用氨甲环酸（TA）具有一定作用。
本研究旨在评估术前单次大剂量注射TA对预防HNC手术患者失血及红细胞输血的有效性。
一项前瞻性、双盲、随机对照研究。
2007年7月至2010年1月期间，在一家三级护理医院，80例年龄在35 - 55岁、美国麻醉医师协会分级为II - III级、计划行单侧HNC手术的患者被随机分为两组，一组接受剂量为20 mg/kg的TA（T组），用生理盐水稀释至25 cc；另一组接受等量生理盐水（C组）。术前及术后测量血红蛋白（Hb）浓度、血小板计数、红细胞压积、纤维蛋白原水平、D - 二聚体水平。
生理盐水（C）组因失血需要更多的血液、胶体液、晶体液。T组中，32例患者无需输注任何血液制品，而C组为5例（P < 0.0001）；T组仅输注了8单位血液，而C组共输注了42单位血液。即使经过多次输血，C组术后6小时和24小时的Hb%仍显著低于T组（P < 0.05）。
因此，TA可显著减少HNC手术引起的失血以及胶体液、血液和晶体液的输注几率。
