Dr Md Mamunur Rashid, Assistant Professor, Department of Neurosurgery, Uttara Adhunik Medical College and Hospital, Dhaka, Bangladesh.
Mymensingh Med J. 2024 Oct;33(4):1088-1096.
Traumatic brain injury (TBI) is a major cause of morbidity and mortality in Bangladesh and also worldwide. Secondary brain injury from progressive intracerebral hematoma, increasing cerebral edema, raised intracranial pressure and subsequent cerebral ischemia is the main cause for morbidity and mortality following TBI. Secondary brain injury is worsened by post-traumatic coagulopathy, which occurs in brain injured patients and is associated with increase in risk of death and morbidity. The antifibrinolytic agent tranexamic acid (TXA) reduces the hematoma expansion and demonstrated improved clinical outcome also reduced the mortality and morbidity. This was a randomized controlled trial (RCT) done in the Department of Neurosurgery, Dhaka Medical College and Hospital. Included patients were randomized to get either the intravenous tranexamic acid (Group A) or placebo (Group B) treatment based on a computer-generated code list (50 patients in each group) along with usual medical management for traumatic brain injury. The extent of contusion expansion (hematoma plus perihematomal oedema) as the primary outcome at 48 hour after admission and was measured by brain CT scan. The contusion and oedema volume were calculated both the times (on admission and after 48 hours). Glasgow coma scale (GCS) after 48 hours and Glasgow outcome scale (GOS) after 7 days were observed. In this study showed increase in hematoma volume in both groups (p<0.05). But the increased hematoma volume in the Group A was significantly less than that in the control group. The mean total hemorrhage expansion was (1.5±1.1) ml and (4.6±1.9) ml in the Group A and Group B, respectively. In Group A- 02(4.0%) patients required operation, whereas in Group B- 11(22.0%) patients required operation. The result was significant (p=0.023) between groups. Therefore use of tranexamic acid is associated with lesser hematoma volume progression. Mean GCS (after 48 hours), mean GOS (after 7 days) result were significantly better in Group A (p<0.001). This study concluded that tranexamic acid has beneficial effect on the patient with significant traumatic brain injury. Tranexamic acid helps in reduction of intracerebral progression of contusion and improvement of clinical outcomes in patients with TBI.
创伤性脑损伤（TBI）是孟加拉国和全球发病率和死亡率的主要原因。继发于进行性颅内血肿、脑水肿加重、颅内压升高和随后的脑缺血的二次脑损伤是 TBI 后发病率和死亡率的主要原因。创伤后凝血病使继发性脑损伤恶化，这种情况发生在脑损伤患者中，并与死亡和发病率增加有关。抗纤维蛋白溶解剂氨甲环酸（TXA）可减少血肿扩大，并显示出改善的临床结果，也降低了死亡率和发病率。这是在达卡医学院和医院神经外科进行的一项随机对照试验（RCT）。纳入的患者根据计算机生成的代码列表（每组 50 名患者）随机分为接受静脉注射氨甲环酸（A 组）或安慰剂（B 组）治疗，并接受常规脑外伤治疗。入院后 48 小时的挫伤扩展（血肿加血肿周围水肿）程度作为主要结局，并通过脑部 CT 扫描测量。两次（入院时和入院后 48 小时）计算挫伤和水肿体积。入院后 48 小时的格拉斯哥昏迷量表（GCS）和入院后 7 天的格拉斯哥预后量表（GOS）。本研究显示两组血肿体积均增加（p<0.05）。但 A 组的血肿增加量明显少于对照组。总出血量扩张的平均值（A 组为 1.5±1.1）ml 和（B 组为 4.6±1.9）ml。A 组中有 02（4.0%）名患者需要手术，而 B 组中有 11（22.0%）名患者需要手术。结果在两组之间有显著差异（p=0.023）。因此，使用氨甲环酸与血肿体积进展减少有关。A 组的平均 GCS（入院后 48 小时）、平均 GOS（入院后 7 天）结果明显更好（p<0.001）。本研究得出结论，氨甲环酸对严重创伤性脑损伤患者有有益的影响。氨甲环酸有助于减少脑挫伤的颅内进展，并改善 TBI 患者的临床结局。
