氨甲环酸的使用对脑瘫患儿股骨内翻旋转截骨术后失血及输血率的影响。
Impact of tranexamic acid use on blood loss and transfusion rates following femoral varus derotational osteotomy in children with cerebral palsy.
作者信息
Nazareth A, Shymon S J, Andras L, Goldstein R Y, Kay R M
机构信息
Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, California, USA.
出版信息
J Child Orthop. 2019 Apr 1;13(2):190-195. doi: 10.1302/1863-2548.13.180143.
PURPOSE
Previous studies have established the safety and efficacy of tranexamic acid (TXA) in reducing blood loss after total joint arthroplasty and spinal fusion surgery; however, literature regarding the effectiveness of intraoperative TXA in children with cerebral palsy (CP) is limited. The aim of this study was to investigate the safety and efficacy of intraoperative TXA in reducing blood loss and transfusion requirements for children with CP undergoing a proximal femoral varus derotational osteotomy (VDRO).
METHODS
This is a retrospective review of 258 children with CP who underwent VDRO performed at the author's institution between 2004 and 2017. In all, 36 subjects underwent VDRO surgery with administration of intravenous TXA and 222 subjects underwent VDRO without administration of TXA. Outcome measures including blood loss, transfusion requirements and venous thromboembolic events were compared between groups using t-tests and chi-squared tests.
RESULTS
No significant differences were seen in the rates of transfusion between groups for the entire hospitalization (TXA group: 11.1% versus No TXA group: 19.8%), intraoperatively (TXA: 2.8% versus No TXA: 9.0%) or postoperatively (TXA: 8.3% versus No TXA: 14.4%). Intraoperative estimated blood loss (TXA: 144.4 mL versus No TXA: 159.0 mL) and percentage blood loss (TXA: 8.9% versus No TXA: 9.2%) were similar between groups. No major thromboembolic complications events occurred in either group.
CONCLUSION
The use of TXA was not associated with thromboembolic complications in this series of children with CP undergoing VDRO surgery. Though there was a trend toward lower rates of intraoperative and postoperative blood transfusion with TXA use in these patients, the differences were not significant, possibly due to low estimated blood loss in both groups and sample size.
LEVEL OF EVIDENCE
III- retrospective comparative study.
目的
既往研究已证实氨甲环酸（TXA）在减少全关节置换术和脊柱融合手术后失血方面的安全性和有效性；然而，关于术中使用TXA对脑瘫（CP）患儿有效性的文献有限。本研究的目的是探讨术中使用TXA对接受股骨近端内翻旋转截骨术（VDRO）的CP患儿减少失血及输血需求的安全性和有效性。
方法
这是一项对258例在作者所在机构于2004年至2017年间接受VDRO手术的CP患儿的回顾性研究。总共36例受试者在VDRO手术中接受了静脉注射TXA，222例受试者在VDRO手术中未使用TXA。使用t检验和卡方检验比较两组之间包括失血、输血需求和静脉血栓栓塞事件在内的结果指标。
结果
在整个住院期间（TXA组：11.1% 对比 无TXA组：19.8%）、术中（TXA组：2.8% 对比 无TXA组：9.0%）或术后（TXA组：8.3% 对比 无TXA组：14.4%），两组之间的输血率没有显著差异。两组之间术中估计失血量（TXA组：144.4 mL对比无TXA组：159.0 mL）和失血百分比（TXA组：8.9%对比无TXA组：9.2%）相似。两组均未发生重大血栓栓塞并发症事件。
结论
在这组接受VDRO手术的CP患儿中，使用TXA与血栓栓塞并发症无关。尽管在这些患者中使用TXA有降低术中和术后输血率的趋势，但差异不显著，可能是由于两组估计失血量较低以及样本量的原因。
证据级别
III - 回顾性比较研究。
Zotero 插件