Couture Pierre, Lebon Jean-Sébastien, Laliberté Éric, Desjardins Georges, Chamberland Marie-Ève, Ayoub Christian, Rochon Antoine, Cogan Jennifer, Denault André, Deschamps Alain
Department of Anesthesiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
Department of Anesthesiology, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.
J Cardiothorac Vasc Anesth. 2017 Oct;31(5):1611-1617. doi: 10.1053/j.jvca.2017.04.026. Epub 2017 Apr 15.
The incidence of postoperative nonischemic seizures associated with the use of tranexamic acid (TXA) and the possibility of prevention with a low-dose regimen of TXA were evaluated.
Retrospective study.
Tertiary care university hospital.
A total of 12,195 patients who underwent cardiac surgical procedures under cardiopulmonary bypass (CPB) were evaluated.
The files of every clinical seizure case diagnosed in the surgical intensive care unit between April 2006 and April 2014 were reviewed. Patients who experienced a postoperative seizure underwent a cerebral computed tomography scan to exclude an ischemic lesion. Dosage and type of antifibrinolytic used and surgery characteristics were retrieved from perfusion files. Low-dose TXA was defined as 1,000-mg bolus, 400-mg/h infusion, and 500 mg in CPB priming. High-dose TXA was defined as 30-mg/kg bolus, 15 mg/kg/h, and 2 mg/kg in CPB priming.
No seizure was observed in the 886 patients who did not receive antifibrinolytics. A total of 98 clinical seizures (0.8%) were recorded in the intensive care unit, and ischemic cause was excluded in the majority of them after computed tomography scan results were reviewed (91 patients [93%]). Low-dose TXA was associated with fewer seizures than was high-dose TXA (46 of 7,452 cases [0.70%] v 34 of 2,190 cases [1.55%], respectively; p < 0.0001). Open-chamber cardiac surgery also was linked to a higher incidence of seizures compared with revascularization (80 of 6,662 [1.20%] and 11 of 5,533 [0.20%], respectively; p < 0.0001).
Lower doses of TXA were associated with a lower incidence of nonischemic seizures compared with higher doses of the drug.
评估与使用氨甲环酸（TXA）相关的术后非缺血性癫痫发作的发生率以及采用低剂量TXA方案预防的可能性。
回顾性研究。
三级医疗大学医院。
共评估了12195例在体外循环（CPB）下接受心脏手术的患者。
回顾了2006年4月至2014年4月期间在外科重症监护病房诊断的每例临床癫痫发作病例的档案。经历术后癫痫发作的患者接受了脑部计算机断层扫描以排除缺血性病变。从灌注档案中获取抗纤溶药物的剂量和类型以及手术特征。低剂量TXA定义为：推注1000mg，输注速度为400mg/h，CPB预充液中含500mg。高剂量TXA定义为：推注30mg/kg，输注速度为15mg/kg/h，CPB预充液中含2mg/kg。
886例未接受抗纤溶药物的患者未观察到癫痫发作。重症监护病房共记录了98例临床癫痫发作（0.8%），在复查计算机断层扫描结果后，大多数病例排除了缺血性病因（91例[93%]）。与高剂量TXA相比，低剂量TXA导致的癫痫发作较少（分别为7452例中的46例[0.70%]和2190例中的34例[1.55%]；p<0.0001）。与血管重建术相比，开胸心脏手术的癫痫发作发生率也较高（分别为6662例中的80例[1.20%]和5533例中的11例[0.20%]；p<0.0001）。
与高剂量TXA相比，低剂量TXA导致的非缺血性癫痫发作发生率较低。
