Department of Otolaryngology, Head and Neck Surgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA.
Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.
Int Forum Allergy Rhinol. 2023 Sep;13(9):1584-1591. doi: 10.1002/alr.23127. Epub 2023 Feb 6.
Postoperative epistaxis is a known possibility following endoscopic sinonasal surgery. Tranexamic acid (TXA) has been shown to reduce intraoperative blood loss and improve the visual field. This study evaluated the clinical efficacy of TXA when given at end of surgery to reduce postoperative bleeding.
This randomized, double-blinded placebo-controlled trial was conducted from April to November 2021. Patients scheduled to undergo endoscopic sinus or nasal surgery were randomized to receive an intravenous dose of 1 g TXA or saline intraoperatively prior to extubation. A 10-in. visual analog scale (VAS) was used to query patients regarding postoperative bleeding each day for 1 week. The medical record was examined to determine the need for additional evaluations or interventions for epistaxis.
Forty patients completed the study. The mean ± SD postoperative bleeding VAS for the TXA group on the day of surgery was not significantly different from the saline group (4.82 ± 2.18 in. vs. 5.03 ± 2.14 in., p = 0.8). There were no significant differences between treatment arms on any postoperative day through day 7 (0.67 ± 1.84 in. vs. 0.87 ± 0.99 in., p = 0.7), nor in the reduction in VAS compared to the respective baseline on the day of surgery. There were no significant differences in terms of additional interventions (e.g., additional evaluation in recovery, ED, or clinic, need for packing, or return to the operating room [OR]).
Although TXA has previously demonstrated efficacy to reduce intraoperative bleeding during sinonasal surgery, when postoperative bleeding is already minimal at baseline, TXA does not appear to reduce it significantly further.
鼻内镜鼻窦手术后有发生术后鼻出血的已知可能性。氨甲环酸（TXA）已被证明可减少术中失血量并改善视野。本研究评估了在手术结束时给予 TXA 以减少术后出血的临床疗效。
这是一项随机、双盲、安慰剂对照试验，于 2021 年 4 月至 11 月进行。计划接受鼻内镜鼻窦或鼻腔手术的患者随机接受术中静脉滴注 1g TXA 或生理盐水，在拔管前。术后第 1 天至第 7 天，患者每天通过 10 英寸视觉模拟量表（VAS）查询术后出血情况。检查病历以确定是否需要进一步评估或干预鼻出血。
40 名患者完成了研究。TXA 组在手术当天的平均术后出血 VAS 与生理盐水组无显著差异（4.82±2.18 英寸与 5.03±2.14 英寸，p=0.8）。在术后第 1 天至第 7 天的任何一天，治疗组之间均无显著差异（0.67±1.84 英寸与 0.87±0.99 英寸，p=0.7），与手术当天的各自基线相比，VAS 降低也无显著差异。在额外干预措施方面（例如，在恢复室、急诊室或诊所进行额外评估、需要填塞或返回手术室）也无显著差异。
尽管 TXA 先前已证明在鼻内镜鼻窦手术中可减少术中出血，但在基线时术后出血已很少的情况下，TXA 似乎不能进一步显著减少出血。
