氨甲环酸与肺部并发症：一项东部创伤外科协会多中心试验的二次分析
Tranexamic Acid and Pulmonary Complications: A Secondary Analysis of an EAST Multicenter Trial.
作者信息
Raza Shariq S, Tatum Danielle, Nordham Kristen D, Broome Jacob M, Keating Jane, Maher Zoe, Goldberg Amy J, Chang Grace, Mendiola Pla Michelle, Haut Elliott R, Tatebe Leah, Toraih Eman, Anderson Christofer, Ninokawa Scott, Maluso Patrick, Burruss Sigrid, Reeves Matthew, Coleman Lauren E, Shatz David V, Goldenberg-Sandau Anna, Bhupathi Apoorva, Spalding Chance, LaRiccia Aimee, Bird Emily, Noorbakhsh Matthew R, Babowice James, Nelson Marsha C, Jacobson Lewis E, Williams Jamie, Vella Michael, Dellonte Kate, Hayward Thomas Z, Holler Emma, Lieser Mark J, Berne John D, Mederos Dalier R, Askari Reza, Okafor Barbara, Etchill Eric, Fang Raymond, Roche Samantha L, Whittenburg Laura, Bernard Andrew C, Haan James M, Lightwine Kelly L, Norwood Scott H, Murry Jason, Gamber Mark A, Carrick Matthew M, Bugaev Nikolay, Tatar Antony, Duchesne Juan, Taghavi Sharven
机构信息
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
出版信息
Am Surg. 2025 Jan;91(1):107-114. doi: 10.1177/00031348241268109. Epub 2024 Aug 7.
BACKGROUND
Anti-inflammatory effects of tranexamic acid (TXA) in reducing trauma endotheliopathy may protect from acute lung injury. Clinical data showing this benefit in trauma patients is lacking. We hypothesized that TXA administration mitigates pulmonary complications in penetrating trauma patients.
MATERIALS AND METHODS
This is a post-hoc analysis of a multicenter, prospective, observational study of adults (18+ years) with penetrating torso and/or proximal extremity injury presenting at 25 urban trauma centers. Tranexamic acid administration in the prehospital setting or within three hours of admission was examined. Participants were propensity matched to compare similarly injured patients. The primary outcome was development of pulmonary complication (ARDS and/or pneumonia).
RESULTS
A total of 2382 patients were included, and 206 (8.6%) received TXA. Of the 206, 93 (45%) received TXA prehospital and 113 (55%) received it within three hours of hospital admission. Age, sex, and incidence of massive transfusion did not differ. The TXA group was more severely injured, more frequently presented in shock (SBP < 90 mmHg), developed more pulmonary complications, and had lower survival ( < 0.01 for all). After propensity matching, 410 patients remained (205 in each cohort) with no difference in age, sex, or rate of shock. On logistic regression, increased emergency department heart rate was associated with pulmonary complications. Tranexamic acid was not associated with different rate of pulmonary complications or survival on logistic regression. Survival was not different between the groups on logistic regression or propensity score-matched analysis.
CONCLUSIONS
Tranexamic acid administration is not protective against pulmonary complications in penetrating trauma patients.
背景
氨甲环酸（TXA）在减轻创伤性内皮病变方面的抗炎作用可能预防急性肺损伤。目前缺乏在创伤患者中显示此益处的临床数据。我们假设给予TXA可减轻穿透性创伤患者的肺部并发症。
材料与方法
这是一项对在25个城市创伤中心就诊的成年（18岁及以上）穿透性躯干和/或近端肢体损伤患者进行的多中心、前瞻性、观察性研究的事后分析。研究了在院前环境或入院后三小时内给予氨甲环酸的情况。对参与者进行倾向匹配以比较伤情相似的患者。主要结局是肺部并发症（急性呼吸窘迫综合征和/或肺炎）的发生。
结果
共纳入2382例患者，206例（8.6%）接受了TXA。在这206例中，93例（45%）在院前接受了TXA，113例（55%）在入院后三小时内接受了TXA。年龄、性别和大量输血发生率无差异。TXA组受伤更严重，更频繁出现休克（收缩压<90 mmHg），发生更多肺部并发症，生存率更低（所有差异均<0.01）。倾向匹配后，剩余410例患者（每组205例），年龄、性别或休克发生率无差异。逻辑回归分析显示，急诊科心率增加与肺部并发症相关。逻辑回归分析显示，氨甲环酸与肺部并发症发生率或生存率的差异无关。逻辑回归分析或倾向评分匹配分析显示，两组生存率无差异。
结论
给予氨甲环酸对穿透性创伤患者的肺部并发症无保护作用。
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