Tulane University School of Medicine, Department of Surgery, Division of Trauma and Critical Care, New Orleans, Louisiana.
Tulane University School of Medicine, Department of Surgery, Division of Trauma and Critical Care, New Orleans, Louisiana.
J Surg Res. 2022 Dec;280:469-474. doi: 10.1016/j.jss.2022.06.017. Epub 2022 Sep 1.
Tranexamic acid (TXA) protects the vasculature endothelium after hemorrhage, resulting in a decreased capillary leak. These properties may protect patients receiving TXA from acute respiratory distress syndrome (ARDS), however, clinical studies have yet to examine this topic. We hypothesized that trauma patients receiving TXA would have lower incidence of ARDS.
This was a retrospective review of adult (18+ y) patients who presented to a large Level I trauma center with an injury severity score ≥ 16 from admit years 2012-2020. Propensity matching was employed to examine how TXA administration is associated with ARDS.
There were a total of 2751 patients meeting study criteria, with 162 (5.9%) received TXA. Of the 162 patients that received TXA, only 12 (7.4%) received pre-hospital TXA, while 4 (2.5%) received TXA both pre-hospital and in hospital. Of the 63 patients developing ARDS, 62 (98.4%) did not receive TXA. After propensity matching, 304 patients remained, with 152 in each cohort. The incidence of ARDS (P = 0.08), pneumonia (P = 0.68), any pulmonary complication (P = 0.33), and mortality (P = 0.37) were not different in patients receiving TXA on propensity matching.
TXA did not protect trauma patients from pulmonary complications; however, nearly all patients developing ARDS did not receive TXA. Larger studies should examine this relationship to improve understanding of therapies that may prevent ARDS.
氨甲环酸（TXA）可保护出血后血管内皮，减少毛细血管渗漏。这些特性可能使接受 TXA 的患者免于急性呼吸窘迫综合征（ARDS），但临床研究尚未对此进行研究。我们假设接受 TXA 的创伤患者 ARDS 的发生率较低。
这是一项回顾性研究，纳入了 2012 年至 2020 年期间因损伤严重程度评分≥16 岁而在一家大型一级创伤中心就诊的成年（≥18 岁）患者。采用倾向匹配法研究 TXA 给药与 ARDS 的相关性。
共有 2751 例符合研究标准的患者，其中 162 例（5.9%）接受了 TXA。在接受 TXA 的 162 例患者中，仅有 12 例（7.4%）接受了院前 TXA，而 4 例（2.5%）接受了院前和院内 TXA。在发生 ARDS 的 63 例患者中，有 62 例（98.4%）未接受 TXA。在进行倾向匹配后，仍有 304 例患者，每组 152 例。在接受 TXA 治疗的患者中，ARDS 的发生率（P=0.08）、肺炎（P=0.68）、任何肺部并发症（P=0.33）和死亡率（P=0.37）在两组之间没有差异。
TXA 不能保护创伤患者免受肺部并发症的影响；然而，几乎所有发生 ARDS 的患者都未接受 TXA。需要更大规模的研究来探讨这种关系，以更好地了解可能预防 ARDS 的治疗方法。
