Eustache G, Riffaud L
Rennes University, CHU of Rennes, Department of Anesthesiology, 35000 Rennes, France.
Rennes University, CHU of Rennes, Department of Neurosurgery, 35000 Rennes, France; INSERM MediCIS, Unit U1099 LTSI, Rennes 1 University, 35000 Rennes, France.
Neurochirurgie. 2019 Nov;65(5):302-309. doi: 10.1016/j.neuchi.2019.09.020. Epub 2019 Oct 3.
Craniosysnostosis surgical corrections are routine procedures in the pediatric neurosurgical field. However, these procedures result in significant blood loss. Tranexamic acid (TXA) is an antifibrinolytic drug, which has demonstrated a significant reduction in perioperative blood loss in many pediatric surgical procedures such as cardiac surgery and scoliosis surgery. We conducted a systematic review to evaluate protocols of TXA use in pediatric craniosynostosis procedures and its effect on intraoperative blood loss and transfusions.
A comprehensive literature review of the National Library of Medicine (PubMed) database was performed to identify relevant studies. We included any clinical study reporting on blood loss or blood transfusion for pediatric craniosynostosis surgery with intraoperative use of tranexamic acid, with the following limits: publication date from inception to May 2019; reports in English.
Thirteen studies were eligible for our review. Of the 13 studies, 4 were prospective, randomised, double-blind controlled trials, 9 were retrospective studies, tailored as a "before-after" studies, comparing blood loss and transfusion without/with TXA. TXA significantly decreases the number and volume of packed red blood cell transfusions and the rate of transfusion in children undergoing craniosynostosis surgery. Significantly fewer fresh frozen plasma transfusions were required in the TXA groups in 2 randomised studies. Length of stay in hospital was significantly lower with the use of TXA in three studies. Advantages of TXA administration also include an excellent patient tolerance of side effects, ease of administration and low cost.
TXA significantly reduces blood loss and the need for transfusions in children undergoing craniosynostosis surgery. TXA administration should be a routine part of strategy to reduce blood loss and limit transfusions in these procedures.
颅骨缝早闭手术矫正是小儿神经外科领域的常规手术。然而，这些手术会导致大量失血。氨甲环酸（TXA）是一种抗纤溶药物，已证明在许多小儿外科手术（如心脏手术和脊柱侧弯手术）中能显著减少围手术期失血。我们进行了一项系统评价，以评估小儿颅骨缝早闭手术中使用TXA的方案及其对术中失血和输血的影响。
对美国国立医学图书馆（PubMed）数据库进行全面的文献检索，以确定相关研究。我们纳入了任何关于小儿颅骨缝早闭手术术中使用氨甲环酸的失血或输血情况的临床研究，有以下限制条件：发表日期从开始到2019年5月；英文报告。
13项研究符合我们的评价标准。在这13项研究中，4项为前瞻性、随机、双盲对照试验，9项为回顾性研究，设计为“前后”研究，比较有无TXA时的失血和输血情况。TXA显著减少了接受颅骨缝早闭手术儿童的红细胞输注数量和体积以及输血率。在2项随机研究中，TXA组所需的新鲜冰冻血浆输注明显较少。在3项研究中，使用TXA可显著缩短住院时间。TXA给药的优点还包括患者对副作用的耐受性良好、给药方便且成本低。
TXA显著减少了接受颅骨缝早闭手术儿童的失血和输血需求。在这些手术中，TXA给药应成为减少失血和限制输血策略的常规组成部分。
