Departments of Anesthesia.
Orthopedic Surgery, Shriners Hospital for Children, Spokane.
J Pediatr Orthop. 2021 Jul 1;41(6):333-337. doi: 10.1097/BPO.0000000000001820.
Previous studies have demonstrated that the use of tranexamic acid (TXA) reduces blood loss and transfusion requirements in children undergoing scoliosis surgery. Although TXA is safe and effective, significant adverse events have been reported. Using the lowest effective dose of TXA is advisable. We evaluated a new low dosing regimen for TXA based on an improved pharmacokinetic model and therapeutic plasma concentration. The purpose of this study is to evaluate the effectiveness of this new low dosing regimen in reducing blood loss and transfusion requirements in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion when compared with a control group who did not receive TXA.
We retrospectively reviewed 90 consecutive patients with idiopathic scoliosis undergoing posterior spinal fusion at our institution from 2017 to 2020. Forty patients received TXA at the new dosing regimen (10 mg/kg load, 5 mg/kg/h infusion) and 50 patients were in the non-TXA control group. The same 2 orthopaedic surgeons, working as a team, performed all surgical procedures. We assessed the use of TXA as an independent risk factor for estimated blood loss and transfusion requirement after adjusting for age, surgical duration, body mass index, major coronal curve, and sex.
A comparison of the intraoperative cumulative blood loss in the 2 groups showed a significantly lower blood loss in the TXA group. (583.5±272.0 vs. 479.5±288.7 mL, P=0.03) This difference persisted when blood loss was calculated as percent of total blood volume and per vertebral level. Transfusion requirements were lower in the TXA group (4/50 patients vs. 0/40 patients, P=0.13). No patient in the TXA group required a blood transfusion during their hospitalization.
This study is the first to provide evidence that a new low dosing regimen of TXA can significantly reduce blood loss and transfusion requirements for idiopathic scoliosis patients and supports the need for a prospective, randomized clinical trial to confirm these findings.
Level III-retrospective cohort study.
先前的研究表明，使用氨甲环酸（TXA）可减少接受脊柱侧凸手术的儿童的失血量和输血需求。尽管 TXA 是安全有效的，但已报告了一些重大不良事件。使用最低有效剂量的 TXA 是明智的。我们基于改进的药代动力学模型和治疗性血浆浓度评估了 TXA 的新低剂量方案。本研究的目的是评估该新低剂量方案在减少接受后路脊柱融合术的青少年特发性脊柱侧凸患者的失血量和输血需求方面的有效性，与未接受 TXA 的对照组相比。
我们回顾性分析了 2017 年至 2020 年在我院接受后路脊柱融合术的 90 例特发性脊柱侧凸连续患者。40 例患者接受 TXA 新剂量方案（负荷 10mg/kg，5mg/kg/h 输注），50 例患者为非 TXA 对照组。由同两位骨科医生组成的团队进行所有手术。我们评估了 TXA 的使用作为调整年龄、手术持续时间、体重指数、主要冠状曲度和性别后估计失血量和输血需求的独立危险因素。
两组术中累积失血量的比较显示，TXA 组失血量明显减少。（583.5±272.0 vs. 479.5±288.7 mL，P=0.03）当以总血容量百分比和每椎体水平计算失血时，这种差异仍然存在。TXA 组输血需求较低（50 例患者中有 4 例 vs. 40 例患者中有 0 例，P=0.13）。TXA 组无患者在住院期间需要输血。
本研究首次提供了证据表明，TXA 的新低剂量方案可显著减少特发性脊柱侧凸患者的失血量和输血需求，并支持需要进行前瞻性、随机临床试验来证实这些发现。
III 级-回顾性队列研究。
