Department of Anaesthesiology, Aarhus University Hospital, Denmark.
Department of Anaesthesiology, Aarhus University Hospital, Denmark.
Br J Anaesth. 2019 Jun;122(6):760-766. doi: 10.1016/j.bja.2019.02.017. Epub 2019 Apr 2.
Tranexamic acid (TXA) reduces intraoperative blood loss and transfusion during paediatric craniosynostosis surgery. Additional reduction of postoperative blood loss may further reduce exposure to allogeneic blood products. We studied the effect of combined intra- and postoperative TXA treatment on postoperative blood loss in children.
Thirty children admitted for craniosynostosis surgery were randomised to combined intra- and postoperative TXA treatment or placebo. The primary endpoint was postoperative blood loss. Secondary endpoints included total blood loss, transfusion requirements, and clot stability evaluated by tissue plasminogen activator-stimulated clot lysis assay.
TXA reduced postoperative blood loss by 18 ml kg (95% confidence interval 8.9) and total blood loss from a mean of 52 ml kg (standard deviation [SD]; 20) ml kg to 28 (14) ml kg (P<0.001). Intraoperative red blood cell (RBC) and fresh frozen plasma (FFP) transfusions were reduced in the treatment group from RBC 14.0 (5.2) ml kg to 8.2 (5.1) ml kg (P=0.01) and from FFP 13.0 (6.3) ml kg to 7.8 (5.9) ml kg (P=0.03). Postoperative RBC transfusion median was 5 (inter-quartile range [IQR] 0-6) ml kg in the placebo group and 0 (0-5.7) ml kg in the TXA group. Resistance to lysis was higher in the treatment group (P<0.001).
Combined intra- and postoperative tranexamic acid treatment reduced postoperative and overall blood loss and transfusion requirements. Improved clot stability represents a possible mechanism for blood loss reduction.
氨甲环酸（TXA）可减少小儿颅缝早闭手术中的术中失血量和输血。进一步减少术后失血可能会进一步减少对同种异体血液制品的暴露。我们研究了联合应用术中及术后 TXA 对儿童术后失血的影响。
30 名因颅缝早闭而入院的儿童随机分为联合应用术中及术后 TXA 治疗组或安慰剂组。主要终点是术后失血量。次要终点包括总失血量、输血需求以及通过组织纤溶酶原激活物刺激的纤维蛋白溶解试验评估的凝块稳定性。
TXA 减少了 18ml/kg 的术后失血（95%置信区间为 8.9），从平均 52ml/kg（标准差[SD]；20）降至 28ml/kg（14）（P<0.001）。治疗组术中红细胞（RBC）和新鲜冷冻血浆（FFP）的输血减少，从 RBC 14.0（5.2）ml/kg 降至 8.2（5.1）ml/kg（P=0.01）和从 FFP 13.0（6.3）ml/kg 降至 7.8（5.9）ml/kg（P=0.03）。安慰剂组术后 RBC 输血中位数为 5（四分位距[IQR] 0-6）ml/kg，TXA 组为 0（0-5.7）ml/kg。治疗组的纤溶抵抗更高（P<0.001）。
联合应用术中及术后 TXA 可减少术后和总失血量及输血需求。改善的凝块稳定性可能是减少失血的机制之一。
