Institute of Medical Technology, Peking University Health Science Center, Beijing, China.
Peking University Third Hospital, Beijing, China.
Biomed Res Int. 2020 Nov 28;2020:3101358. doi: 10.1155/2020/3101358. eCollection 2020.
To evaluate the efficacy and safety of different dose regimens of intravenous (IV) tranexamic acid (TXA) in adolescent spinal deformity surgery.
Two researchers independently searched multiple databases, including PubMed, Embase, Cochrane Library, and Web of Science to find studies that met the inclusion criteria. A meta-analysis was performed based on the guidelines of the .
Six randomized controlled trials (RCTs) and eleven non-RCTs were identified, including 1148 patients. According to different dose regimens of IV TXA, the included studies were divided into the high-dose group and the low-dose group. Compared with placebo, both groups had less total blood loss (TBL) (high dose: WMD = -1737.55, 95% CI: (-2247.16, -1227.94), < 0.001, = 0%; low dose: WMD = -528.67, 95% CI: (-666.06, -391.28), < 0.001, = 0%), intraoperative blood loss (IBL) (high dose: WMD = -301.48, 95% CI: (-524.3, -78.66), = 0.008, = 60.3%; low dose: WMD = -751.14, 95% CI: (-967.21, -535.08), < 0.001, = 0%), and blood transfusion rates (high dose: RR = 0.19, 95% CI: (0.1, 0.37), < 0.001, = 0%; low dose: RR = 0.4, 95% CI: (0.18, 0.91), = 0.029, = 57%). High-dose IV TXA use was associated with more vertebral fusion segments (WMD = 0.53, 95% CI: (0.23, 0.82), < 0.001, = 31.2%). Low-dose IV TXA use was associated with shorter operative time (WMD = -18.43, 95% CI: (-26.68, -10.17), < 0.001, = 0%).
High-dose and low-dose IV TXA were effective in reducing TBL, IBL, and blood transfusion rates without increasing complications in adolescent patients undergoing spinal deformity surgery. Low-dose IV TXA was effective in reducing the operative time. Both the high-dose and low-dose groups had similar preoperative and postoperative Hb levels compared to the control group.
评估不同剂量静脉注射氨甲环酸（TXA）在青少年脊柱畸形手术中的疗效和安全性。
两位研究人员独立检索了多个数据库，包括 PubMed、Embase、Cochrane 图书馆和 Web of Science，以找到符合纳入标准的研究。根据 进行了荟萃分析。
共纳入 6 项随机对照试验（RCT）和 11 项非随机对照试验，共 1148 名患者。根据静脉注射 TXA 的不同剂量方案，将纳入的研究分为高剂量组和低剂量组。与安慰剂相比，两组的总失血量（TBL）均减少（高剂量：WMD = -1737.55，95%CI：（-2247.16，-1227.94），<0.001， = 0%；低剂量：WMD = -528.67，95%CI：（-666.06，-391.28），<0.001， = 0%），术中失血量（IBL）（高剂量：WMD = -301.48，95%CI：（-524.3，-78.66），= 0.008， = 60.3%；低剂量：WMD = -751.14，95%CI：（-967.21，-535.08），<0.001， = 0%）和输血率（高剂量：RR = 0.19，95%CI：（0.1，0.37），<0.001， = 0%；低剂量：RR = 0.4，95%CI：（0.18，0.91），= 0.029， = 57%）。高剂量 IV TXA 应用与更多的椎体融合节段相关（WMD = 0.53，95%CI：（0.23，0.82），<0.001， = 31.2%）。低剂量 IV TXA 应用与手术时间缩短相关（WMD = -18.43，95%CI：（-26.68，-10.17），<0.001， = 0%）。
高剂量和低剂量 IV TXA 可有效减少青少年脊柱畸形手术患者的 TBL、IBL 和输血率，且不增加并发症。低剂量 IV TXA 可有效缩短手术时间。与对照组相比，高剂量和低剂量组的术前和术后 Hb 水平相似。
