| 张庄,杨曦,汪雷,等.青少年特发性脊柱侧凸矫形术后多次口服与静脉应用氨甲环酸对于降低术后失血量及输血率的回顾性研究.骨科,2023,14(1): 46-51. |
| 青少年特发性脊柱侧凸矫形术后多次口服与静脉应用氨甲环酸对于降低术后失血量及输血率的回顾性研究 |
| Effect of Multiple-dose Oral vs. Intravenous Tranexamic Acid in Reducing Postoperative Blood Loss and Transfusion Rate after Adolescent Scoliosis Surgery: A Retrospective Study |
| 投稿时间：2022-09-28 |
| DOI：10.3969/j.issn.1674-8573.2023.01.010 |
| 中文关键词: 氨甲环酸 多次给药 青少年特发性脊柱侧凸 矫形手术 |
| 英文关键词: Tranexamic acid Multiple-dose Adolescent idiopathic scoliosis Corrective surgery |
| 基金项目:国家自然科学基金面上项目（82072386） |
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| 中文摘要: |
| 目的 评估术后多次应用氨甲环酸能否有效降低青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）病人术后的失血量以及输血率，以及口服和静脉给药是否具有等效性。方法 回顾性分析2018年1月至2021年1月于我院行矫形手术的AIS病人的临床资料，筛选出术中采取同一给药方案给予氨甲环酸的病人：切皮前静脉滴注50 mg/kg氨甲环酸并以10 mg/kg/h持续滴注至手术结束。根据不同的术后给药方案将其分为口服组（于术后4、10、16 h口服1 g氨甲环酸），静脉组（于术后6、12、18 h静滴0.5 g氨甲环酸）以及对照组（术后不给予氨甲环酸）。共有214例病人符合纳入标准。为提高组间可比性，本研究按口服组人数配平每组样本量，最终每组各纳入50例病人。记录并比较三组病人的术后失血量、输血率、引流量、凝血指标以及并发症等。结果 口服组、静脉组的术后失血量［（961.2±311.2） mL、（974.5±392.1） mL］和输血率（12%、14%）均显著低于对照组［（1 451.2±408.1） mL、36%］，差异有统计学意义（P＜0.05）。此外，口服组、静脉组的术后引流量、最大血红蛋白丢失值显著低于对照组，血红蛋白最低值显著高于对照组，差异有统计学意义（P＜0.05），但口服组和静脉组间比较，差异无统计学意义（P＞0.05）。三组病人术前、术后第1~3天的凝血指标比较，差异均无统计学意义（P＞0.05），且所有病人均未发生静脉血栓、肝肾功能异常等药物相关并发症。结论 术后多次给予氨甲环酸可以有效降低矫形术后失血量及输血率，口服给药与静脉给药具有等效性。 |
| 英文摘要: |
| Objective To determine whether the postoperative multiple-dose regimen of tranexamic acid (TXA) could reduce postoperative blood loss (PBL) and transfusion rates in corrective surgery, and to compare the efficacy of oral administration and intravenous administration. Methods A retrospective analysis was performed on patients who underwent corrective surgery between January 2018 and January 2021. The patients who received the same intraoperative protocol of TXA were screened out: receiving intravenous TXA 50 mg/kg loading does and 10 mg/kg/h maintenance during surgery. They were divided into three groups based on their postoperative regimen: oral group (orally receiving 1 g TXA at 4 h, 10 h, and 16 h postoperatively), intravenous group (intravenously receiving 0.5 g TXA at 6 h, 12 h, and 18 h postoperatively), and control group (not receiving any TXA postoperatively). A total of 214 patients met the inclusion criteria. To improve the comparability between groups, the sample size was matched to the number of patients in oral group, and finally 50 patients were included in each group. The PBL, transfusion rate, drainage volume, coagulation indicators, and complications were recorded and compared among the three groups. Results The PBL and transfusion rate in oral group and intravenous group were significantly lower than those in control group ［(961.2±311.2) mL vs. (974.5±392.1) mL vs. (1 451.2±408.1) mL, 12% vs. 14% vs. 36%, P＜0.05］. Besides, similar results were observed in the decreases of drainage volume and maximum Hb. No significant difference was observed in coagulation indicators among the three groups at each time point. No drag-related complications such as vein thrombosis, liver and kidney dysfunction were observed in all the patients. Conclusion The postoperative multiple-dose regimen of TXA could effectively reduce the PBL and transfusion rate in patients who underwent corrective surgery. The oral administration was equivalent to intravenous administration in this condition. |
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