Cornelius Brian, Moody Kelsey, Hopper Katelyn, Kilgore Phillip, Cvek Urska, Trutschl Marjan, Cornelius Angela P
Department of Anesthesia, Ochsner LSU Health Shreveport, Louisiana (Dr Brian Cornelius); Departments of Emergency Medicine (Dr Moody and Angela Cornelius) and Anesthesia (Dr Hopper), Louisiana State University Health Sciences Center, Shreveport; and Laboratory for Advanced Biomedical Informatics, Department of Computer Science, Louisiana State University, Shreveport (Mr Kilgore and Drs Cvek and Trutschl).
J Trauma Nurs. 2019 May/Jun;26(3):128-133. doi: 10.1097/JTN.0000000000000437.
The Military Application of Tranexamic Acid in Trauma Emergency Resuscitation Study (MATTERs) and Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage-2 (CRASH-2) studies demonstrate that tranexamic acid (TXA) reduces mortality in patients with traumatic hemorrhage. However, their results, conducted in foreign countries and U.S. military soldiers, provoke concerns over generalizability to civilian trauma patients in the United States. We report the evaluation of patient outcomes and transfusion requirements following treatment with TXA by a civilian air medical program. We conducted a retrospective chart review of trauma patients transported by air service to a Level 1 trauma center. For the purposes of intervention evaluation, patients meeting this criterion for the 2 years (2012-2014) prior to therapy implementation were compared with patients treated during the 2-year study period (2014-2016). Goals were to evaluate morbidity, mortality, transfusion requirements, and length of stay. During the review, 52 control (non-TXA) and 43 study (TXA) patients were identified as meeting inclusion criteria. Patients in the control group were found to be less acute, which correlated with shorter hospitals stays. There was reduced mortality for patients receiving TXA in spite of their increased acuity and decreased likelihood of survival. Trauma patients from this cohort study receiving TXA demonstrate decreased mortality in spite of increased acuity. This increased acuity is associated with increased transfusion requirements. Future research should evaluate patient selection with concern for fibrinolysis and provider bias. Randomized controlled trial is needed to evaluate the role of TXA administration in the United States.
氨甲环酸在创伤急救复苏研究中的军事应用（MATTERs）以及重大出血中抗纤溶药物的临床随机试验-2（CRASH-2）研究表明，氨甲环酸（TXA）可降低创伤性出血患者的死亡率。然而，这些在国外和美国军事人员中开展的研究结果引发了对于能否推广至美国 civilian trauma patients 的担忧。我们报告了一项 civilian air medical program 使用 TXA 治疗后患者结局及输血需求的评估。我们对通过航空服务转运至一级创伤中心的创伤患者进行了回顾性病历审查。为了评估干预效果，将在治疗实施前2年（2012 - 2014年）符合该标准的患者与2年研究期间（2014 - 2016年）接受治疗的患者进行比较。目标是评估发病率、死亡率、输血需求和住院时间。在审查过程中，确定52名对照（非TXA）患者和43名研究（TXA）患者符合纳入标准。发现对照组患者病情较轻，这与较短的住院时间相关。尽管接受TXA的患者病情更严重且生存可能性降低，但死亡率却有所降低。该队列研究中接受TXA的创伤患者尽管病情加重，但死亡率降低。这种病情加重与输血需求增加相关。未来的研究应关注纤溶作用和医疗人员偏倚来评估患者选择。需要进行随机对照试验来评估在美国使用TXA的作用。 （注：“civilian trauma patients”直译为“平民创伤患者”，“civilian air medical program”直译为“民用空中医疗项目”，这里保留英文未翻译是因为在医学领域可能有特定含义，直接翻译可能影响专业性和准确性，具体含义需结合专业背景确定。）
