氨甲环酸在脊柱手术中的应用及研究进展

Administration and research progress of tranexamic acid in patients undergoing major spine surgery

行脊柱侧凸矫形手术的患者常因术中大出血而需输血。虽然近年来血液制品的安全性得到显著提高,但仍存在感染性和非感染性风险。且输血与患者发病率和死亡率之间存在紧密联系。因此围术期常采用许多措施如抗纤溶药物来减少脊柱矫形手术过程的出血量,从而降低输血需求。由于抑肽酶可能会增加肾功能不全、心血管不良事件、肺栓塞等并发症的发生率,FDA于2007年11月宣布暂停使用抑肽酶。目前临床常用的抗纤溶药物是赖氨酸类似物——氨甲环酸。脊柱侧凸矫形手术中使用氨甲环酸,一方面可以减少患者出血量,保护血液,避免因输血而造成患者住院费用的增加;另一方面术后患者未出现如癫痫等神经系统并发症,也未增加静脉血栓发生率。本综述旨在探讨氨甲环酸脊柱手术的应用及研究进展。

The patients undergoing scoliosis correction surgery are always associated with considerable blood loss, and thus requiring transfusion. The safety of the blood supply has been greatly improved in recent years. Howev- er, the risk of infection and noninfectious com- plications still exist to the patients. It is shown that connection between transfusion and morbid- ity and mortality is significantly tight. Thus, rigorous efforts including antifibrinolytic agents have been made to surgical bleeding and the need for blood product transfusion in the surgical cor- rection of scoliosis. Since aprotinin can increase the risk of intraoperative renal dysfunction, car- diovascular events and pulmonary embolism, the US Food and Drug Administration （FDA） sus- pend aprotinin from the market in November 2007. At present, the most commonly used anti-fibrinolytic drug is the tranexamic acid （TXA）, which is a lysine analog. The use of tranexamic acid in the surgical correction of scoliosis, one hand, can reduce the perioperative blood loss, help the blood conservation, and avoid the in- ereasement of hospitalization costs due to trans- fusion; the other hand, use of tranexamic acid can also reduce the risk of neurological adverse events such as convulsive seizures during postop- erative period; and also decrease the incidence of venous thrombosis. The objective of this review is to discuss the administration and to assess the research progress of tranexamic acid in patients undergoing major spine surgery.