氨甲环酸和间断负压引流对腰椎术后引流量的影响

[目的]探讨联合局部应用氨甲环酸(TXA)和间断负压引流对腰椎后路椎间融合术后出血量的影响。[方法]按照前瞻性对照方法收集2016年02月～2019年03月行开放性单或双节段腰椎后路椎间融合手术患者214例,随机分为使用TXA和持续负压引流者52例(A组)、未使用TXA和间断负压引流者54例(B组),使用TXA和间断负压引流者55例(C组),未使用TXA和持续负压引流者53例(D组)。对四组性别、年龄、手术节段、术中出血量、术后引流量、术后隐性失血量、引流管留置时间、术后输血人数以及并发症等进行分析。[结果]四组患者年龄、性别、手术节段方面差异无统计学意义(P>0.05);四组患者在术中出血量、术后隐性失血量、术后输血人数以及并发症发生率方面差异无统计学意义(P>0.05)。术后引流量与总出血量统计得出了一致的结果,即A组与B组的差异无统计学意义(P>0.05),但均显著少于D组,差异有统计学意义(P>0.05);C组显著少于A组、B组和D组,差异有统计学意义(P<0.05)。在术后拔管时间方面,C组最早,与其他各组相比差异具有统计学意义(P<0.05);其次是A组和B组,而D组与其他三组相比明显延长,差异具有统计学意义(P<0.05)。[结论]对于开放性单节段或双节段腰椎融合手术,联合局部使用TXA和间断负压引流可以明显减少术后引流量和总出血量,缩短引流管留置时间。     

静脉滴注氨甲环酸联合局部“氨甲环酸鸡尾酒”疗法在股骨转子间骨折内固定中的应用研究

目的探讨在股骨转子间骨折闭合复位股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定术中,静脉滴注氨甲环酸(tranexamic acid,TXA)联合局部注射"TXA鸡尾酒"减少围术期失血及缓解早期疼痛的安全性及有效性。方法以2018年2月—2019年3月拟行闭合复位PFNA内固定的股骨转子间骨折患者作为研究对象,其中45例患者符合选择标准纳入研究。采用随机数字表法将患者随机分为3组(n=15),空白对照组(A组)不使用TXA,静脉应用组(B组)仅术前静脉滴注1.0 g TXA,静脉联合局部应用组(C组)术前静脉滴注1.0 g TXA联合术中局部应用"TXA鸡尾酒"。3组患者性别、年龄、体质量指数、骨折AO分型、病程、合并内科疾病比较,差异均无统计学意义(P0.05)。比较3组患者围术期失血量及输血情况,术前及术后12、24、48 h疼痛视觉模拟评分(VAS),术前及术后1、3 d ELISA法检测炎症因子前列腺素E2(prostaglandin E2,PGE2)与缓激肽(bradykinin,BK)表达水平,术后并发症发生情况,以及术前及术后3、7 d血栓弹力图最大振幅值。结果 B、C组总失血量、隐性失血量、显性失血量均明显少于A组(P0.05),C组总失血量、隐性失血量明显少于B组(P0.05)。3组输血率差异无统计学意义(P0.05)。3组患者术前VAS评分及PGE2、BK表达水平比较,差异均无统计学意义(P0.05);术后各时间点C组PGE2、BK表达水平及VAS评分均明显低于A、B组(P0.05)。血栓弹力图显示3组术前及术后3、7 d最大振幅值差异均无统计学意义(P0.05)。术后A组5例(33.33%)、B组3例(20.00%)、C组2例(13.33%)发生并发症,3组并发症发生率比较差异无统计学意义(χ~2=1.721,P=0.550)。结论股骨转子间骨折闭合复位PFNA内固定术中,通过静脉滴注TXA联合局部注射"TXA鸡尾酒"可以明显减少围术期失血量、减轻患者术后疼痛,而且不增加并发症发生风险。     

静脉输注不同维持剂量氨甲环酸减少脊柱手术出血量的安全性分析

目的探讨持续静脉输入不同剂量氨甲环酸(Tranexamic acid,TXA)以减少脊柱手术出血量的有效性及安全性。方法回顾性分析2017-03—2020-03采用脊柱矫形手术治疗的98例脊柱疾病。49例术中较高剂量维持TXA(HM组),49例术中较低剂量维持TXA(LM组)。比较2组术中出血量、术中输血量、术后使用TXA数、术后输血数,比较2组术后1、2、3 d D-二聚体(D-Dimer,D-D)水平以及术后1 d血液血清肌酐(Serum creatinine,SCr)值与序贯器官衰竭评分(Sequential organ failure assessment,SOFA)。结果 2组均顺利完成手术,随访时间1~3个月,平均2.3个月。未出现深筋脉血栓、肺部栓塞等并发症。2组术中出血量、术中输血量、术后使用TXA数、术后输血数、术后1 d血液SCr值与SOFA评分比较差异无统计学意义(P>0.05),HM组术后1、2、3 d D-D水平低于LM组,差异有统计学意义(P<0.05)。结论脊柱矫形手术中静脉输注较高剂量维持TXA和较低剂量维持TXA止血疗效相同,但较高剂量维持TXA和安全性较高。     

氨甲环酸降低脊柱侧凸围手术期出血量的有效性和安全性分析

目的 分析氨甲环酸降低脊柱侧凸围手术期出血量的有效性与安全性.方法 将38例行后路脊柱侧凸矫形术患者按照是否使用氨甲环酸分为A组(22例)和B组(16例).A组术前15 min静脉输注100 mg/kg氨甲环酸,术中以10 mg/(kg·h)氨甲环酸维持至术毕;B组术前输注与A组等量的生理盐水.比较两组手术时间、融合固...     

三种氨甲环酸联合用药方案在初次人工全膝关节置换术中的疗效比较北大核心CSCD

目的比较初次人工全膝关节置换术(total knee arthroplasty,TKA)中静脉滴注联合关节腔内注射不同剂量氨甲环酸(tranexamic acid,TXA)减少术后失血效果的差异。方法根据选择标准,研究共纳入2017年1月–6月收治的90例单侧膝关节骨关节炎患者,随机分为A、B、C 3组,每组30例。3组患者在术中止血带充气前10 min静脉滴注TXA 1 g;关闭切口后,A、B、C组分别于关节腔内注射含1、2、3 g TXA的生理盐水50 mL。3组患者性别、年龄、体质量指数、患膝侧别、骨关节炎病程及分期、美国麻醉医师协会(ASA)分级以及术前血红蛋白(hemoglobin,Hb)、血小板计数、凝血酶原时间、活化部分凝血酶原时间比较,差异均无统计学意义(P>0.05)。记录术后切口引流量,术后1、3、7 d血红蛋白(Hb)值以及输血率,术后彩色多普勒超声检查下肢深静脉血栓形成以及症状性肺栓塞发生情况。结果 3组患者术后均获随访,随访时间7～12个月,平均8.4个月。A、B、C组手术时间比较差异无统计学意义(P>0.05);B、C组引流量明显少于A组(P<0.05),B、C组间比较差异无统计学意义(P>0.05)。术后B组1例发生切口皮缘坏死,C组1例发生切口脂肪液化,其余患者切口均Ⅰ期愈合。3组切口并发症发生率比较,差异无统计学意义(P>0.05)。B、C组术后1、3、7 d Hb均高于A组(P<0.05),B、C组间仅术后1 d时差异有统计学意义(P<0.05)。术后A、B、C组分别有9例(30%)、4例(13.3%)、5例(16.7%)患者输血;A组输血率明显高于B、C组(P<0.05),B、C组间比较差别无统计学意义(P>0.05)。双下肢静脉彩色多普勒超声检查显示,3组中仅B组有1例患者在术后3周时健侧腘静脉以下深静脉血栓形成。结论 TKA术前静脉滴注1 g TXA联合术毕关节腔内注射2 g TXA,能有效减少术后出血,降低输血患者比例,且不增加血栓性疾病风险。     

3种入路手术治疗胸椎结核的疗效

目的回顾性分析前后路联合手术以及前路、后路手术治疗胸椎结核的疗效。方法 84例胸椎结核患者(病灶≤2个节段),根据手术入路的不同分为A组(前路手术)、B组(后路手术)和C组(前后路联合手术),每组28例。比较3组患者的手术时间、术中出血量、红细胞沉降率(ESR)、C-反应蛋白(CRP)水平、Cobb角情况以及术后并发症。结果 84例患者均随访1年。手术时间、术中出血量C组明显短(少)于A组和B组(P 0. 05)。术后3个月及末次随访时ESR、CRP、Cobb角3组均明显低于术前(P 0. 05),C组均明显低于A组和B组(P 0. 05)。3组术后并发症发生率比较差异无统计学意义(P 0. 05)。结论 3种入路手术治疗胸椎结核均取得较好疗效。相较于前路、后路手术治疗,前后路联合手术治疗的临床效果更为满意。     

氨甲环酸不同给药途径对膝关节置换失血量的影响

[目的]探讨氨甲环酸不同给药途径对全膝关节置换术失血量的影响。[方法]120例拟行初次单侧全膝关节置换术患者,随机分为A、B、C、D四组,每组30例。A组在缝合关节囊后经引流管向关节腔内灌注溶于50ml生理盐水的氨甲环酸(tranexamic acid,TXA)1 g;B组术前0.5 h静滴TXA 20 mg/kg+100 ml生理盐水;C组关闭关节囊前关节周围软组织注射TXA 1 g+100 ml生理盐水;D组在缝合关节囊后向关节腔内灌注50 ml生理盐水。记录围手术期失血量、输血量、输血率、术后血红蛋白浓度和术后3 h纤维蛋白原、凝血酶原时间、活化部分凝血活酶时间、皮下瘀斑、深静脉血栓形成、患膝周径变化率等指标。[结果]A、B、C三组和D组两两比较,围手术期失血量、输血量和输血率明显减少,差异有统计学意义(P<0.05),A、B、C三组组间比较差异无统计学意义(P>0.05);术后血红蛋白浓度A、B、C三组明显高于D组(P<0.05),A、B、C三组组间比较差异无统计学意义(P>0.05);四组患者术后3 h纤维蛋白原、凝血酶原时间和活化部分凝血活酶时间比较差异无统计学意义(P>0.05)。A、B、C三组皮下瘀斑率和患膝周径变化率低于D组,差异有统计学意义(P<0.05)。术后未发现下肢深静脉血栓形成及肺梗塞、心肌梗塞、脑梗塞等血栓相关事件发生。[结论]在全膝关节置换术中应用TXA能明显减少围手术期失血量,降低输血率和输血量,尤其是关节腔内灌注TXA既可以减少失血又可以避免静脉给药可能带来的并发症。     

输注预热液体防治老年患者术中低温的临床观察

目的 观察输注预热胶体及晶体液对行开腹子宫切除术的老年患者体温、凝血功能及乳酸(LAC)的影响.方法 选择择期开腹子宫切除术的老年患者40例,随机均分为A、B两组.A组术中输注预热至40℃的6%羟乙基淀粉和复方乳酸钠;B组输注室温的同样液体.患者入室输注6%羟乙基淀粉5 ml/kg后行腰-硬联合麻醉(CSEA),再输注6%羟乙基淀粉5 ml/kg后切皮,随后输注6%羟乙基淀粉至1 000 ml,最后输注复方乳酸钠.记录入室时、CSEA时、切皮时及切皮后30、60、90及120 min的鼻咽温度(NT)及腋部与手指温差(△T)、LAC值,同时记录术前、术后凝血酶原时间(PT)和活化部分凝血激酶时间(APTT)、手术失血量及寒颤发生率.结果 麻醉后A组各时点NT明显高于B组(P＜0.05),△T明显小于B组(P＜0.05).A组术后PT、APTT较B组明显缩短(P＜0.05),出血量、寒颤发生率明显低于B组(P＜0.05).结论 输注预热胶体及晶体液能有效提高患者术中的鼻咽温度,减少外周血管的痉挛,改善凝血功能,减少术中出血量及寒颤的发生率.     

三种手术方法治疗相邻三节段脊髓型颈椎病的比较

目的 比较颈椎前路椎间盘切除植骨融合术、颈椎前路椎体次全切除联合椎间盘切除植骨融合术、颈椎后路单开门椎管扩大成形术治疗相邻三节段脊髓型颈椎病的临床疗效。方法 回顾性分析自2016-08—2021-08诊治的61例相邻三节段脊髓型颈椎病,16例采用颈椎前路椎间盘切除植骨融合术治疗（A组）,20例采用颈椎前路椎体次全切除减压联合椎间盘切除植骨融合术治疗（B组）,25例采用颈椎后路单开门椎管扩大成形术治疗（C组）。比较3组的手术时间、出血量、术后C-反应蛋白、肌酸激酶水平以及术后JOA评分。结果 61例均获得随访,随访时间平均21(12～32)个月。A组与B组手术时间差异无统计学意义（P>0.05）,而C组手术时间多于A组和B组（P<0.05）。A组出血量最少,B组出血量又少于C组,差异有统计学意义（P<0.05）。A组术后第1天的C-反应蛋白水平最低,而B组低于C组,差异有统计学意义（P<0.05）。A组与B组术后第1天的肌酸激酶水平差异无统计学意义（P>0.05）,而C组术后第1天的肌酸激酶水平高于A组和B组（P<0.05）。3组术后6、12个月JOA...     

全膝关节置换术中静脉与局部应用氨甲环酸止血效果比较

目的比较在初次行单侧全膝关节置换(TKA)术中静脉与局部应用氨甲环酸(TXA)的止血效果。方法将380例初次行单侧TKA患者按照应用TXA方式及不应用TXA分成3组:1静脉滴注组:术中静脉滴注TXA 30 mg/kg,120例;2局部注射组:将1.5 g TXA溶入50 ml生理盐水中,术中关节腔内多点注射,136例;3不应用组:术中不应用TXA,124例。术前及术后第1、2、3天连续测量术侧肢体周径,对术中失血量、术后引流量、输血情况、深静脉血栓形成(DVT)等情况进行观察。结果患者均获得随访,时间12~18个月。3组手术时间、术中失血量、术后引流量、异体血输注量、DVT及术侧肢体周径比较差异均无统计学意义(P0.05);输血率、术后隐性失血量、失血总量:静脉滴注组、局部注射组均明显低于不应用组,差异有统计学意义(P0.05),静脉滴注组与局部注射组比较差异无统计学意义(P0.05)。结论在初次行单侧TKA中,静脉及局部应用TXA均有良好的止血效果,能明显减少患者的出血量,且不增加DVT的风险。两种用法之间无明显差异。     

口服和静脉注射氨甲环酸对于腰椎椎管减压融合术的围手术期失血量影响

目的 ：探讨氨甲环酸（tranexamic acid,TXA）不同给药方式对腰椎椎管减压融合术围手术期失血量、隐性出血量、输血率,以及不良反应等各方面的影响。方法：对2019年7月至2020年7月接受腰椎椎管减压融合术的60例患者进行回顾性分析,根据TXA不同给药方式分为观察组和对照组,每组30例。观察组术前2 h口服2 g TXA;对照组在切皮前5～10 min予以1 g TXA静脉输注,术后6 h予以1 g TXA静脉输注1次。分别记录两组患者术中出血量、术后引流量、总失血量、隐性失血量、引流管拔除时间、输血率、静脉血栓形成率、不良事件发生率,观察术前和术后1、3 d血红蛋白（hemoglobin,Hb）,红细胞比容（hematocrit,HCT）的变化情况。结果：术后1、3 d的Hb及HCT均较术前有明显改善（P<0.01）,但组间比较差异无统计学意义（P>0.05）。两组术中出血量、术后引流量、总失血量、术中失血量、隐性失血量、拔管时间、输血率比较差异无统计学意义（P>0.05）。两组患者均未见静脉血栓形成和不良事件发生。结论：在腰椎椎管减压融合术围手术期口服...     

Hemostatic and Anti-Inflammatory Effects of Carbazochrome Sodium Sulfonate in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial

BackgroundPostoperative recovery after total knee arthroplasty (TKA) is associated with postoperative anemia, allogeneic transfusion, and stress immune responses to surgery. Carbazochrome sodium sulfonate (CSS) reduces bleeding through several mechanisms. We assessed the effect of CSS combined with tranexamic acid (TXA) on postoperative anemia, blood transfusion, and inflammatory responses.MethodsThis study was designed as a randomized, placebo-controlled trial of 200 patients undergoing unilateral primary TKA. Patients were divided into 4 groups: group A received TXA plus topical and intravenous CSS; group B received TXA plus topical CSS only; group C received TXA plus intravenous CSS only; group D received TXA only.ResultsTotal blood loss in groups A (609.92 ± 221.24 mL), B (753.16 ± 247.67 mL), and C (829.23 ± 297.45 mL) was lower than in group D (1158.26 ± 334.13 mL, P < .05). There was no difference in total blood loss between groups B and C. We also found that compared with group D, the postoperative swelling rate, biomarker level of inflammation, visual analog scale pain score, and range of motion at discharge in groups A, B, and C were significantly improved (P < .05). No thromboembolic complications occurred. There were no differences in transfusion rate, intraoperative blood loss, platelet count, or average length of stay among the 4 groups (P > .05).ConclusionCSS combined with TXA was more effective than TXA alone in reducing perioperative blood loss and inflammatory response and did not increase the incidence of thromboembolism complications.     

大剂量氨甲环酸降低脊柱结核患者围手术期出血风险

目的探讨预防性应用大剂量氨甲环酸能否有效减少脊柱结核围手术期出血及相关不良事件。方法选择本院2016年1月-2018年12月行一期经椎间孔入路病灶切除椎间植骨融合内固定术治疗的腰椎结核患者90例,随机分为小剂量氨甲环酸治疗组(小剂量组)、大剂量氨甲环酸治疗组(大剂量组)和对照组,每组30例。所有患者全身抗结核治疗2~3周后行一期经椎间孔入路病灶切除椎间植骨融合内固定治疗。小剂量组静脉泵注含1 mg/kg氨甲环酸的生理盐水50 mL,大剂量组泵注含15 mg/kg氨甲环酸的生理盐水50 mL,对照组泵注等量生理盐水,均于术前30 min开始泵注。记录手术时间,术中和术后出血时间、出血量、输血量,手术前后凝血功能,术后引流量、血红蛋白量及红细胞比容,住院时间、术后恢复时间及其他不良事件。结果3组患者手术时间、术中及术后出血时间、术后出血量及输血量、手术前后凝血功能、住院时间、术后恢复时间差异均无统计学意义(P>0.05)。大剂量组术中出血量及输血量和术后引流量均较小剂量组和对照组降低,差异有统计学意义(P<0.05),小剂量组与对照组差异无统计学意义(P>0.05)。大剂量组术后血红蛋白水平、术后红细胞比容均高于小剂量组及对照组,差异有统计学意义(P<0.05),小剂量组与对照组之间差异无统计学意义(P>0.05)。所有患者围手术期均未发生手术部位感染、血管和神经损伤及静脉血栓等严重并发症。所有患者术后随访8~12个月,椎间植骨均获得骨性融合,未发生假关节形成,内固定物断裂、松动、脱落等情况。所有患者结核症状消失,病灶全部愈合,无复发。结论术前预防性应用大剂量氨甲环酸可降低脊柱结核患者围手术期出血风险,且不增加不良事件发生风险。     

氨甲环酸不同用药途径对女性股骨颈骨折全髋关节置换术失血的疗效分析

目的：研究氨甲环酸不同应用方式治疗老年女性股骨颈骨折行全髋关节置换术围手术期失血的疗效。方法：将2015年12月至2018年1月老年女性股骨颈骨折行全髋关节置换术患者77例分成4组：A组（静脉用药组）21例,年龄（77.10±7.02）岁,于手术切皮前5 min使用15 mg/kg氨甲环酸静脉滴注并且术中生理盐水灌注关节腔;B组（局部用药组）18例,年龄（73.83±6.56）岁,于手术切皮前5 min生理盐水静脉滴注并且术中使用总剂量为3 g的氨甲环酸灌注关节腔;C组（联合用药组）19例,年龄（74.26±6.04）岁,术前使用15 mg/kg氨甲环酸静滴并且术中使用总剂量为1.5 g的氨甲环酸灌注关节腔;D组（对照研究组）19例,年龄（76.69±9.27）岁,于手术切皮前5 min生理盐水静脉滴注并且术中生理盐水灌注关节腔。记录术后伤口引流量、血红蛋白变化,根据身高体重和手术前后的红细胞压积（HCT）计算所有患者的总失血量等。结果：A组术后引流量为（111.91±35.02） ml,血红蛋白改变量为（26.86±12.99） g/L,总失血量为（628.6±306.78） ml;B组术后引流量为（108.89±36.61） ml,血红蛋白改变量为（26.28±8.59） g/L,总失血量为（584.41±250.86） ml;C组术后引流量为（102.63±47.36） ml,血红蛋白改变量为（26.89±12.47） g/L,总失血量为（634.78±384.89） ml;D组术后引流量为（107.37±40.53） ml,血红蛋白改变量为（40.95±12.48） g/L,总失血量为（1 005.24±483.37） ml。4组术后引流量比较差异无统计学意义（P>0.05）;A、B、C组术后血红蛋白改变量、总失血量少于对照组D组（P<0.05）,但是3组组间比较差异无统计学意义（P>0.05）。结论：应用氨甲环酸能有效减少老年女性股骨颈骨折行全髋关节置换术围手术期失血,但是最佳给药方式及给药剂量需要进一步的研究。     

Safety and efficacy of perioperative tranexamic acid infusion in acetabular fracture fixation: A randomized placebo-controlled double-blind prospective study

IntroductionOpen reduction and internal fixation of acetabular fracture is associated with significant blood loss. Although Tranexamic acid (TXA) infusion effectively reduces perioperative blood loss and transfusion requirements in elective orthopedic surgery, its efficacy in major orthopedic trauma surgery is controversial.Material and methodsSixty-three patients undergoing open reduction and internal fixation of acetabular fracture were randomized into either TXA (n = 36) or placebo (n = 27) group. TXA group received a bolus dose of TXA (10 mg/kg) 15 min prior to incision, followed by another similar dose after 3 h of surgery. The placebo group received the same volume of normal saline similarly. All patients were operated on by a single pelviacetabular surgeon with a uniform perioperative protocol. The intraoperative blood loss, drain output, the number of blood transfusions, postoperative hemoglobin (Hb) drop, and hematocrit (Hct) drop were calculated.ResultsBoth groups were similar in relation to age, sex, BMI, preoperative Hb, the timing of surgery, fracture pattern, operative time, and surgical approaches. The mean postoperative Hb was 10.35 ± 1.36 gm% in TXA group and 9.74 ± 1.98 gm% in placebo group (p-value 0.158). There were no differences in intraoperative blood loss (438.11 ml vs. 442.81, p=.947), drain output (131.94 ml vs. 129.63, p=.870), and blood transfusion (8 patients vs. five patients, p=.719) between the groups. The drop in Hb and Hct in the postoperative period was also statistically not significant between the groups.ConclusionThere is no significant reduction in blood loss and blood transfusion with the use of intravenous Tranexamic acid in open reduction and internal fixation of acetabular fractures.     

Blood loss and transfusion rate compared among different dosing regimens of tranexamic acid administration in patients undergoing hip hemiarthroplasty for femoral neck fracture: A randomized controlled trial

BackgroundIntravenous tranexamic acid (TXA) administration is a proven safe and effective method for reducing both blood loss and transfusion in total joint arthroplasty. However, data specific to its efficacy in hip hemiarthroplasty (HHA) for femoral neck fracture are scarce. Furthermore, no study has investigated the efficacy of an additional dose of TXA administration. Accordingly, this study aimed to assess blood loss and the transfusion rate compared among different regimens of TXA administration in patients undergoing HHA for femoral neck fracture.MethodsBetween January 2019 to December 2020, 90 HHA patients were randomized into one of three groups (30 patients/group). Control group patients received intravenous normal saline solution (NSS) 20 mL before skin incision, and NSS 20 mL at 3 hours after surgery. one-dose (1D) group patients received 750 mg of intravenous TXA before skin incision, and NSS 20 mL at 3 hours after surgery. Two-dose (2D) group patients received 750 mg of intravenous TXA before skin incision, and 750 mg of TXA at 3 hours after surgery. The primary outcome was blood transfusion rate. Intraoperative blood loss, hemoglobin levels at 24- and 48-hours postoperation, and calculated total blood loss were compared among the three groups.ResultsThe mean age of the study population was 79.7 years, and 76.7% of participants were women. The transfusion rate in the control, 1D and 2D groups was 43.3%, 16.7%, and 3.3%, respectively. Total hemoglobin loss; total red blood cell loss; intraoperative blood loss; hemoglobin level at 24- and 48-hours postoperation; change in hemoglobin level between 0 and 24 hours, and between 0 and 48 hours; blood transfusion rate; and, the number of patients who did not require blood transfusion were all significantly improved in the 2D group compared to baseline. No parameters were significantly improved in the 1D group compared to controls.ConclusionsThe results of this study demonstrate both the efficacy of TXA administration in HHA, and the superiority of two-dose TXA administration over one-dose TXA administration in HHA for femoral neck fracture.     

The effect of multiple-dose oral versus intravenous tranexamic acid in reducing postoperative blood loss and transfusion rate after adolescent scoliosis surgery: a randomized controlled trial

BACKGROUND CONTEXTTranexamic acid (TXA) is widely used in surgery for adolescent idiopathic scoliosis (AIS) and has been proved to be efficacious in reducing intraoperative blood loss (IBL) and the transfusion rate. However, the routine TXA regimen was intraoperative administration alone, in which the concentration of TXA could not cover the whole process of hyperfibrinolysis. And, its ability to control the massive postoperative blood loss (PBL) may be insufficient. Thus, we promoted a multiple-dose regimen of TXA for patients with AIS who underwent surgical correction.PURPOSEThe primary aims were (1) to determine whether the multiple-dose regimen of TXA could reduce PBL and the postoperative transfusion rate, and (2) to compare the efficacy of oral administration with intravenous administration. The secondary aims were (3) to evaluate whether this regimen could alleviate inflammatory response, and (4) to assess the occurrence of drug-related side effects.STUDY DESIGNProspective, double-blinded, randomized controlled trial.PATIENT SAMPLEA total of 108 patients with AIS who underwent posterior scoliosis correction and spinal fusion (PSS) were enrolled in this study.OUTCOME MEASURESThe primary parameters were PBL and postoperative transfusion rate. Other parameters such as total blood loss (TBL), maximum hemoglobin (Hb) decrease, volume of drainage, inflammation markers (interleukin-6 [IL-6] and C-reactive protein [CRP]), and occurrence of complications were also collected and compared. Multiple regression analysis was used to examine the variables that affected PBL.METHODSPatients were randomized into three groups. All patients received intravenous TXA 50 mg/kg loading dose and 10 mg/kg/h maintenance dose during surgery. Group A received 1 g oral TXA at 4 hours, 10 hours, and 16 hours postoperatively; group B received 0.5 g intravenous TXA at 6 hours, 12 hours, and 18 hours postoperatively; group C received placebo.RESULTSThe mean PBL and postoperative transfusion rate in group A (957.8±378.9 mL, 13.89%) and B (980.3±491.8 mL, 11.11%) were significantly lower than those in group C [1,495.9±449.6 mL, mean differences=538.1 mL, 95% confidence interval (CI), 290.1–786.1 mL, p<0.001; 515.6 mL, 95% CI, 267.6–763.6 mL, p<.001]; (36.11%, p=.029, p=.013). Meanwhile, the mean TBL, maximum Hb decrease, and volume of drainage were also significantly lower in group A and B than in group C. IL-6 and CRP in group A and B were significantly lower than in group C from postoperative days 1 to 3. All these differences were not significant between groups A and B. No drug-related complications were observed in any patient. Multiple regression showed that the application of postoperative TXA and number of screws were significant parameters affecting PBL.CONCLUSIONSA multiple-dose regimen of TXA, either by oral or intravenous application, could be a safe and effective means of controlling PBL and decreasing the postoperative transfusion rate in patients with AIS who underwent scoliosis surgery. In addition, it could inhibit postoperative inflammatory response.     

Combination effect of intraoperative and postoperative intravenous tranexamic acid in hip hemiarthroplasty. A propensity score matched analysis

BackgroundTranexamic acid (TXA) has been proven to reduce perioperative blood loss and the incidence of allogeneic blood transfusion in total joint arthroplasty (TJA). However, there is limited literature on the use of TXA in patients undergoing hip hemiarthroplasty. Furthermore, combination effect of intraoperative and postoperative intravenous TXA has not been investigated extensively. The purpose of this study was to evaluate this combination effect on hip hemiarthroplasty by a propensity score matched analysis (PSMA).MethodsThis is a retrospective cohort study involving hip hemiarthroplasty for femoral neck fracture. All patients received 1g intraoperative intravenous TXA. One group also received 1g intravenous TXA 6h after surgery, while the other group did not. Perioperative blood loss, the incidence of allogeneic blood transfusion and venous thromboembolism (VTE) were collected and compared.Results209 patients who underwent unilateral hip hemiarthroplasty were included. PSMA resulted in 66 matched pairs in each group. There were no significant differences in perioperative blood loss on postoperative day (POD) # 1, 3, 5 (637.2 ± 285.9 versus 653.6 ± 305.5, 726.6 ± 274.2 versus 676.3 ± 313.2, 795.5 ± 291.2 versus 759.9 ± 328.4), the incidence of allogeneic blood transfusion (9.1% versus 12.1%) and VTE (1.5% versus 1.5%) between the two groups (P value> 05) for up to one year.ConclusionIntraoperative and postoperative intravenous TXA have no combination effect on reducing perioperative blood loss, the incidence of allogeneic blood transfusion and VTE in patients undergoing hip hemiarthroplasty.     

Effect of single dose intravenous tranexamic acid on blood loss in tangential excision of burn wounds — A double blind randomised controlled trial

IntroductionThis study was carried out to evaluate role of intravenous tranexamic acid (TXA) in reducing blood loss during tangential excision of burns.MethodsThis was a single center, prospective double-blinded parallel arm superiority randomized placebo-controlled trial. Patients (15?55 years) with deep dermal thermal burns <30% undergoing tangential excision were randomly assigned (1:1) to TXA and placebo groups. Patients in TXA and placebo groups received injection TXA 15 mg/kg and 10 ml saline respectively, 10 min preoperatively. Primary outcome was volume of blood loss per square centimeter area of burn excised. Secondary outcomes were total volume of blood loss, postoperative hemoglobin, intraoperative fluid requirement, blood transfusion, graft take and length of hospitalization (LOH).ResultsThirty patients were included. Both groups were comparable in terms of Body Mass Index (BMI) preoperative hemoglobin, area of burn excised, duration of surgery and the intraoperative temperature. The average blood loss per square centimeter burn area excised was found to be significantly lower in TXA when compared to placebo group (mean difference: 0.28 ± 0.025 ml/cm²; p = 0.000). The total volume of blood loss was lower in TXA group (258.7 ± 124.10 ml vs 388.1 ± 173.9 ml; p = 0.07). None of the patients required transfusion. The requirement of intra-operative fluids was similar between the two groups (crystalloids: p = 0.236; colloids: p = 0.238). Postoperative hemoglobin, length of hospitalization and graft-take were comparable between the two groups.ConclusionTXA reduced blood loss per unit burn area of tangential excision in <30%TBSA burn, however, we found no significant effect on postoperative Hb and transfusion.     

Blood loss and perioperative transfusions related to surgery for spinal tumors. Relevance of tranexamic acid

IntroductionTranexamic acid (TXA) has been shown to reduce bleeding. Patients with spinal tumors are fragile and acute anemia may be harmful. Tumor excision surgery is reputed to be hemorrhagic and treatment may increase thromboembolic complications. The aim of this study was to compare blood loss with or without perioperative TXA injection. The transfusion-related and postoperative complications were documents.MethodThis retrospective analysis of prospectively collected data involved 83 patients with spinal tumors who underwent decompressive surgery associated with bone fixation. Tranexamic acid was used arbitrarily in 36 of them, while the other 47 did not receive TXA. The overall, intraoperative and postoperative blood loss was recorded. Blood loss was reported relative to the number of fixed levels and the number of levels decompressed by laminectomy. Transfusions were quantified in number of red blood cell packets and erythrocyte volume. Postoperative complications were documented.ResultsEpidemiological and morphological data were similar between groups. There were no significant differences between the two groups in the overall, intraoperative, and postoperative blood loss. A significant reduction in postoperative bleeding was found in the TXA group when the volume was related to the number of decompressed levels. A significant reduction (P < 0.05) in the volume of transfused blood was identified in the treated group. No predictor of blood loss was identified, and no additional complications occurred.ConclusionThe efficacy of TXA appears to be moderate during spinal tumor surgery since it does not lead to a reduction in perioperative bleeding. However, a significant reduction in transfusion volume was found without an increase in complications.