高剂量与低剂量氨甲环酸用于减少小儿脊柱侧弯手术中的输血需求
High-dose Versus Low-dose Tranexamic Acid to Reduce Transfusion Requirements in Pediatric Scoliosis Surgery.
作者信息
Johnson Daniel J, Johnson Christine C, Goobie Susan M, Nami Nina, Wetzler Joshua A, Sponseller Paul D, Frank Steven M
机构信息
*Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions§Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD†Department of Orthopedic Surgery, Hospital of Special Surgery, New York, NY‡Department of Anesthesiology, Boston Children's Hospital, Boston, MA.
出版信息
J Pediatr Orthop. 2017 Dec;37(8):e552-e557. doi: 10.1097/BPO.0000000000000820.
BACKGROUND
Our objective was to quantify blood loss and transfusion requirements for high-dose and low-dose tranexamic acid (TXA) dosing regimens in pediatric patients undergoing spinal fusion for correction of idiopathic scoliosis. Previous investigators have established the efficacy of TXA in pediatric scoliosis surgery; however, the dosing regimens vary widely and the optimal dose has not been established.
METHODS
We retrospectively analyzed electronic medical records for 116 patients who underwent spinal fusion surgery for idiopathic scoliosis by a single surgeon and were treated with TXA. In total, 72 patients received a 10 mg/kg loading dose with a 1 mg/kg/h maintenance dose (low-dose) and 44 patients received 50 mg/kg loading dose with a 5 mg/kg/h maintenance dose (high-dose). Estimated blood loss and transfusion requirements were compared between dosing groups.
RESULTS
Patient characteristics were nearly identical between the 2 groups. Compared with the low-dose TXA group, the high-dose TXA group had decreased estimated blood loss (695 vs. 968 mL, P=0.01), and a decrease in both intraoperative (0.3 vs. 0.9 units, P=0.01) and whole hospitalization (0.4 vs. 1.0 units, P=0.04) red blood cell transfusion requirements. The higher-dose TXA was associated with decreased intraoperative (P=0.01), and whole hospital transfusion (P=0.01) requirements, even after risk-adjustment for potential confounding variables.
CONCLUSIONS
High-dose TXA is more effective than low-dose TXA in reducing blood loss and transfusion requirements in pediatric idiopathic scoliosis patients undergoing surgery.
LEVEL OF EVIDENCE
Level-III, retrospective cohort study.
背景
我们的目的是量化接受特发性脊柱侧弯矫正脊柱融合术的儿科患者中高剂量和低剂量氨甲环酸（TXA）给药方案的失血量和输血需求。既往研究已证实TXA在小儿脊柱侧弯手术中的疗效；然而，给药方案差异很大，最佳剂量尚未确定。
方法
我们回顾性分析了116例接受特发性脊柱侧弯脊柱融合手术且接受TXA治疗的患者的电子病历。总共72例患者接受10mg/kg负荷剂量，1mg/kg/h维持剂量（低剂量），44例患者接受50mg/kg负荷剂量，5mg/kg/h维持剂量（高剂量）。比较了给药组之间的估计失血量和输血需求。
结果
两组患者的特征几乎相同。与低剂量TXA组相比，高剂量TXA组的估计失血量减少（695对968mL，P=0.01），术中（0.3对0.9单位，P=0.01）和全住院期间（0.4对1.0单位，P=0.04）红细胞输血需求均减少。即使在对潜在混杂变量进行风险调整后，较高剂量的TXA也与术中（P=0.01）和全住院输血（P=0.01）需求减少相关。
结论
在接受手术的小儿特发性脊柱侧弯患者中，高剂量TXA在减少失血量和输血需求方面比低剂量TXA更有效。
证据级别
III级，回顾性队列研究。
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