Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Republic of Korea.
Int J Med Sci. 2018 May 22;15(8):788-795. doi: 10.7150/ijms.25008. eCollection 2018.
: Distraction osteogenesis for craniosynostosis is associated with significant hemorrhage. Additionally, patients usually require several transfusions. Tranexamic acid (TXA) is effective for reducing blood loss and the need for transfusions during surgeries. However, the significance of TXA infusion has not been thoroughly described yet. : Forty-eight children undergoing distraction osteogenesis for craniosynostosis were administered intraoperative TXA infusion (loading dose of 10 mg/kg for 15 min, followed by continuous infusion at 5 mg/kg/h throughout surgery; n = 23) or normal saline (control, n = 25). Rotational thromboelastometry (ROTEM) was conducted to monitor changes in coagulation perioperatively. : Blood loss during surgery was significantly lower in the TXA-treated group than it was in the control group (81 vs. 116 mL/kg, = 0.003). Furthermore, significantly fewer transfusions of red blood cells and fresh frozen plasma were required in the TXA group. In the control group, clotting time during the postoperative period was longer than it was during the preoperative period. Similarly, clot strength was weaker during the postoperative period. D-dimer levels dramatically increased in the control group compared with the TXA group after surgery. The duration of mechanical ventilation and the number of postoperative respiratory-related complications were significantly greater in the control group than they were in the TXA group. : TXA infusion based on population pharmacokinetic analysis is effective in reducing blood loss and the need for transfusions during the surgical treatment of craniosynostosis. It can also prevent the increase in D-dimer levels without affecting systemic hemostasis.
: 颅缝早闭的牵张成骨术会伴随大量出血。此外，患者通常需要多次输血。氨甲环酸（TXA）可有效减少手术中的失血量和输血需求。然而，TXA 输注的重要性尚未得到充分描述。 : 48 名接受颅缝早闭牵张成骨术的儿童给予术中 TXA 输注（负荷剂量 10mg/kg 输注 15 分钟，然后在手术过程中以 5mg/kg/h 的速度持续输注；n=23）或生理盐水（对照组，n=25）。术中监测 ROTEM 以监测凝血变化。 : TXA 治疗组的术中失血量明显低于对照组（81 比 116ml/kg，P=0.003）。此外，TXA 组需要输注的红细胞和新鲜冷冻血浆明显减少。在对照组中，术后凝血时间比术前长。同样，术后凝血强度较弱。与 TXA 组相比，对照组术后 D-二聚体水平显著升高。对照组机械通气时间和术后与呼吸相关并发症的数量明显多于 TXA 组。 : 基于群体药代动力学分析的 TXA 输注可有效减少颅缝早闭手术治疗中的失血量和输血需求。它还可以防止 D-二聚体水平的升高，而不影响全身止血。
