Gould Daniel, Cui Haoze, Ma Norine, Chalkiadis George, Davidson Andrew, Graham Kerr, Rutz Erich
Department of Paediatrics, The Royal Children's Hospital, University of Melbourne, 50 Flemington Road, Parkville, VIC, 3052, Australia.
Monash Medical Centre, 246 Clayton Rd, Clayton VIC 3168, Melbourne, Australia.
Syst Rev. 2024 Dec 27;13(1):315. doi: 10.1186/s13643-024-02734-7.
Many children with cerebral palsy (CP) are frail and require major hip and/or spine surgeries associated with substantial blood loss. Tranexamic acid (TXA) is commonly used to reduce blood loss, but there is uncertainty around the optimal dose and timing of administration. There have been reviews in sub-populations and specific dosing regimens, but a broad overview of the available literature is lacking. The aim of this review was to map available evidence on TXA in hip and spine surgery for children with CP. Given the heterogeneous literature, a prospectively registered scoping review was conducted. Eligibility criteria were broad. Three screeners were involved, with the senior author consulted when disagreements were not resolved through discussion.Titles and abstracts of 14,609 records were screened, with 52 records included. Two additional records were obtained from grey literature and citation searching. Cohort studies (50.0%) were the most common. Most records (76.9%) were on spine surgery. TXA dose varied widely. Loading doses range from 5 to 100 mg/kg and intraoperative infusions from 1 to 10 mg/kg/h. Dose was not reported in 35.2% of records. Primary outcome measures included blood loss and transfusion requirements. TXA was generally reported to be safe. None of the included records reported postoperative TXA administration.While TXA is generally considered safe, there was mixed evidence on efficacy. Much of the evidence was drawn from studies in which TXA was used in patients at higher risk of bleeding or with reduced physiological reserve. There was no evidence for TXA being used postoperatively, when a large proportion of transfusions occur.
许多脑瘫（CP）患儿体质虚弱，需要进行与大量失血相关的大型髋关节和/或脊柱手术。氨甲环酸（TXA）常用于减少失血，但在最佳剂量和给药时机方面仍存在不确定性。已有针对亚人群和特定给药方案的综述，但缺乏对现有文献的全面概述。本综述的目的是梳理关于TXA在CP患儿髋关节和脊柱手术中应用的现有证据。鉴于文献的异质性，我们进行了一项前瞻性注册的范围综述。纳入标准较为宽泛。有三名筛选人员参与，当讨论无法解决分歧时会咨询资深作者。对14609条记录的标题和摘要进行了筛选，纳入了52条记录。通过灰色文献和引文检索又获得了另外两条记录。队列研究（占50.0%）最为常见。大多数记录（占76.9%）是关于脊柱手术的。TXA剂量差异很大。负荷剂量范围为5至100mg/kg，术中输注剂量为1至10mg/kg/h。35.2%的记录未报告剂量。主要结局指标包括失血量和输血需求。TXA一般被报告为安全的。纳入的记录均未报告术后使用TXA的情况。虽然TXA一般被认为是安全的，但关于其疗效的证据不一。许多证据来自TXA用于出血风险较高或生理储备降低患者的研究。没有证据表明在大量输血发生的术后使用TXA。
