Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.
Departamento de Ortopedia y Traumatología, Area Sur., Universidad de Chile, Gran Avenida Jose Miguel Carrera 3100, San Miguel, Santiago, Chile.
Eur Spine J. 2020 Dec;29(12):3044-3050. doi: 10.1007/s00586-020-06572-8. Epub 2020 Aug 31.
To compare topical tranexamic acid versus intravenous tranexamic acid in reducing intra- and postoperative blood loss and transfusion rate in deformity patients.
We performed a retrospective cohort study with posterior fusion deformity patients, between 2009 and 2016. Patients were categorized in 4 groups: "No TXA" (n = 35) if the wound was packed with saline soaked sponges, "IV TXA" (n = 37) the patient received 20 mg/kg bolus at the beginning of the surgery followed by continuous infusion of 1 mg/kg/hr until closure, "Topical TXA" (n = 23) the wound was packed with sponges soaked in 6 g of TXA diluted in a 3 L saline solution, or "Combined TXA" (n = 86) the patient received both IV and topical TXA. The primary outcomes were total, intra- and postoperative blood loss, surgical time, postoperative Ht/Hb, transfusion rates, and duration of drain insertion.
A total of 181 patients were analyzed (78.6% F, 15.08 yo). No differences were found in total and intraoperative blood loss, surgical time, postoperative Ht/Ht, and transfusion rates. "Combined TXA" group had significantly less postoperative bleeding than "no TXA" group (p = 0.022). IV TXA patients (with o/without topical TXA) removed drains one day earlier than the no TXA group (p = 0.002). There were no complications related to the use of tranexamic acid.
There is significant decrease in postoperative bleeding in pediatric deformity patients with combined topical and IV tranexamic acid.
比较局部使用氨甲环酸（TXA）与静脉注射 TXA 减少畸形患者术中及术后失血量和输血率的效果。
我们进行了一项回顾性队列研究，纳入了 2009 年至 2016 年间行后路融合畸形手术的患者。患者分为 4 组：“无 TXA”组（n=35），即伤口用生理盐水浸泡的纱布填塞；“IV TXA”组（n=37），患者在手术开始时给予 20mg/kg 推注，然后持续输注 1mg/kg/hr 直至缝合；“局部 TXA”组（n=23），伤口用 6g TXA 稀释在 3L 生理盐水溶液中浸泡的纱布填塞；“联合 TXA”组（n=86），患者接受 IV 和局部 TXA。主要结局是总失血量、术中失血量和术后失血量、手术时间、术后 Ht/Hb、输血率和引流管留置时间。
共分析了 181 例患者（78.6%为女性，平均年龄 15.08 岁）。各组间总失血量、术中失血量、手术时间、术后 Ht/Hb 和输血率均无差异。“联合 TXA”组术后出血明显少于“无 TXA”组（p=0.022）。IV TXA 组（无论是否联合局部 TXA）的引流管拔除时间早于“无 TXA”组（p=0.002）。未见与使用 TXA 相关的并发症。
在儿童畸形患者中，联合使用局部和静脉注射 TXA 可显著减少术后出血。
