Shim Sung Ryul, Shin Jieun, Hwang Cheol Mog, Kim Yong Kyun, Park Jong Bum, Kim Jong-Yeup
Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, South Korea.
Konyang Medical Data Research Group-KYMERA, Konyang University Hospital, Daejeon, South Korea.
Sci Rep. 2025 Apr 1;15(1):11132. doi: 10.1038/s41598-025-95038-2.
Ear surgeries such as mastoidectomy require a clear surgical field with minimal bleeding for optimal visualization and outcomes. However, bleeding during these microscopic and endoscopic procedures can obscure the surgeon's view and potentially impact surgical precision and efficiency. The study aimed to identify the effect of intravenous tranexamic acid during ear surgery. PubMed/MEDLINE, Cochrane Library, and Embase were systematically searched from inception through August 31, 2024. Two authors also manually and independently searched all relevant studies. We included RCTs with (1) patients diagnosed with otitis media or middle ear infection; (2) interventions included intravenous tranexamic acid during ear surgery as mastoidectomy; (3) comparisons were specified as normal saline or no treatment; and (4) outcomes were subjective score (bleeding score and surgeon satisfaction), and objective markers (amount of bleeding, duration of surgery, and mean arterial pressure [MAP]). Data extraction was completed independently by 2 extractors and cross-checked for research integrity. The pairwise meta-analysis was performed to compare the treatment group with control used in ear surgery. Hedges' g standardized mean differences (SMDs) and mean difference (MD) were used for improvement in all outcomes. Efficacy outcomes included subjective scores as bleeding score and surgeon satisfaction, as well as objective markers measuring amount of bleeding, duration of surgery, and MAP. A comprehensive literature search was conducted which identified 4 RCTs with 248 patients. In subjective score, the pooled SMD 3.871 (95% CI 0.508, 7.234) for surgeon satisfaction between treatments for controls was significantly increased. In objective markers, the pooled MD for amount of bleeding and MAP were - 28.484 ml (95% CI - 35.785, - 21.182) and - 2.874 mmHg (95% CI - 4.732, - 1.015), indicating that the intravenous tranexamic acid during ear surgery significantly reduced amount of bleeding and MAP. The findings of this meta-analysis indicate that intravenous tranexamic acid can be an effective method for reducing bleeding during ear surgery. This is achieved by significantly improving the surgical field of view and lowering MAP.
诸如乳突切除术之类的耳部手术需要一个清晰的手术视野，出血最少，以实现最佳的可视化效果和手术结果。然而，在这些显微手术和内窥镜手术过程中，出血可能会遮挡外科医生的视野，并可能影响手术的精度和效率。该研究旨在确定静脉注射氨甲环酸在耳部手术中的效果。从创刊到2024年8月31日，我们系统地检索了PubMed/MEDLINE、Cochrane图书馆和Embase。两位作者还手动并独立检索了所有相关研究。我们纳入了以下随机对照试验：（1）诊断为中耳炎或中耳感染的患者；（2）干预措施包括在耳部手术（如乳突切除术）期间静脉注射氨甲环酸；（3）对照设定为生理盐水或不进行治疗；（4）结局指标为主观评分（出血评分和外科医生满意度）以及客观指标（出血量、手术持续时间和平均动脉压[MAP]）。数据提取由2名提取人员独立完成，并进行交叉核对以确保研究的完整性。进行了成对荟萃分析，以比较耳部手术中治疗组与对照组的情况。使用Hedges' g标准化均数差值（SMD）和均数差值（MD）来评估所有结局指标的改善情况。疗效结局指标包括主观评分，如出血评分和外科医生满意度，以及测量出血量、手术持续时间和MAP的客观指标。进行了全面的文献检索，确定了4项随机对照试验，共248例患者。在主观评分方面，治疗组与对照组之间外科医生满意度汇总的SMD为3.871（95%可信区间0.508，7.234），显著提高。在客观指标方面，出血量和MAP的汇总MD分别为-28.484 ml（95%可信区间-35.785，-21.182）和-2.874 mmHg（95%可信区间-4.732，-1.015），表明耳部手术期间静脉注射氨甲环酸可显著减少出血量和降低MAP。该荟萃分析的结果表明，静脉注射氨甲环酸可能是减少耳部手术出血的有效方法。这是通过显著改善手术视野和降低MAP来实现的。
