摘要
目的探讨预防性静脉使用氨甲环酸(TXA)在腹主动脉球囊辅助骨盆肿瘤手术中的有效性及安全性。方法收集2015年1月1日至2019年12月31日在北京大学人民医院行腹主动脉球囊辅助骨盆肿瘤手术的患者资料。根据是否预防性使用TXA,分为TXA组和对照组,采用倾向性评分匹配年龄、性别及术者后,纳入TXA组51例,对照组51例。比较两组患者基线、术中及术后临床资料,探讨预防性使用TXA的效果和安全性。结果2015至2019年共完成腹主动脉球囊辅助骨盆肿瘤手术525例,其中预防性使用TXA 51例,使用率为9.7%。TXA组与对照组患者年龄[(40.7±15.1)岁比(38.2±14.5)岁,P=0.393]、性别(男性:51.0%比49.0%,P=0.843)、体重、体质指数、合并症、美国麻醉医师协会(ASA)分级、血红蛋白、红细胞比容、血小板、凝血功能相关指标、肿瘤病理类型差异均无统计学意义(均P>0.05)。两组患者手术时间、麻醉时间、球囊阻断累积时间、术中出血量、输液量、输血量差异均无统计学意义(均P>0.05);术后ICU入住率、住院天数差异均无统计学意义(均P>0.05),均无静脉血栓栓塞症或死亡者。与对照组比较,TXA组术后24 h输血比例较低(41.2%比70.6%,P=0.003);纤维蛋白原降解产物水平较低[10.4(6.1,22.6)mg/L比13.2(7.0,24.7)mg/L],但差异无统计学意义(P=0.326)。结论预防性静脉使用TXA未减少腹主动脉球囊辅助骨盆肿瘤手术术中出血,但可降低术后输血率。未发现术后TXA相关静脉血栓栓塞症风险增加。
Objective To investigate the efficacy and safety of prophylactic intravenous(IV)administration of tranexamic acid(TXA)in abdominal aorta balloon-assisted pelvic tumor surgery.Methods The data of patients who underwent abdominal aorta balloon-assisted pelvic tumor surgery in Peking University People′s Hospital from January 1,2015 to December 31,2019 were retrospectively collected.According to whether receiving the prophylactic use of TXA,the patients were divided into two groups:TXA group and control group.After propensity score matching based on age,gender and surgeon,51 patients in TXA group and 51 patients in control group were allocated.The baseline,intraoperative and postoperative clinical data of the two groups were compared to explore the efficacy and safety of TXA.Results A total of 525 cases undergoing abdominal aorta balloon-assisted pelvic surgery were enrolled from 2015 to 2019,of which 51 cases received prophylactic use of TXA,with a utilization rate of 9.7%.There were no significant differences in age[(40.7±15.1)years vs(38.2±14.5)years,P=0.393],gender(male:51.0%vs 49.0%,P=0.843),body weight,body mass index(BMI),complications,American Society of Anesthesiologists(ASA)classification,hemoglobin,hemocrit(Hct),platelet,coagulation function-related indexes and tumor pathological types between the two groups(all P>0.05).Likewise,there were no significant differences in operation time,anesthesia time,cumulative time of balloon occlusion,intraoperative blood loss,intravenous fluid volume and blood transfusion volume between the two groups(all P>0.05).Additionally,there were no significant differences in postoperative ICU admission rate and length of hospital stay between the two groups(all P>0.05),and no venous thromboembolism(VTE)or death was reported.Compared with the control group,the rate of blood transfusion at 24 hours after operation in the TXA group was lower(41.2%vs 70.6%,P=0.003).The level of fibrinogen degradation products was lower[10.4(6.1,22.6)mg/L vs 13.2(7.0,24.7)mg/L],but the difference was not statistically significant(P=0.326).Conclusions Prophylactic IV use of TXA does not reduce intraoperative bleeding in abdominal aorta balloon-assisted pelvic tumor surgery,but can decrease the rate of postoperative blood transfusion.No increased risk of postoperative TXA-related VTE was observed.
作者
孙亮
高倩
安海燕
潘芳
冯艺
Sun Liang;Gao Qian;An Haiyan;Pan Fang;Feng Yi(Department of Anesthesiology,Peking University People′s Hospital,Beijing 100044,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2021年第12期851-855,共5页
National Medical Journal of China
关键词
骨肿瘤
骨盆
氨甲环酸
出血
输血
静脉血栓栓塞
Bone neoplasms
Pelvis
Tranexamic acid
Hemorrhage
Blood transfusion
Venous thromboembolism
