氨甲环酸与儿童癫痫外科术中异体输血关系的病例-对照研究

Relationship between tranexamic acid and transfusion demand during children epilepsy surgery:a case-control study

目的探讨术中给予氨甲环酸（TXA）对儿童癫痫外科术中异体输血需求的影响。方法本研究为病例-对照研究,共纳入49例首都医科大学宣武医院神经外科行癫痫病灶切除术的患儿。根据术中是否输注异体成分血分为异体输血组及未异体输血组。比较2组患儿在临床特征、术中术后情况以及应用TXA等方面的差异。结果异体输血组28例（57.1%）,未异体输血组21例（42.9%）。给予TXA是术中不输异体血的保护性措施,其OR值为0.20（95%CI 0.04-0.86）。2组患儿一般情况,术前的血红蛋白、凝血酶原时间、活化部分凝血酶原时间、国际标准化比值及纤维蛋白原均在正常范围,且差异无统计学意义（P〉0.05）。2组手术时间、切除3个及以上脑叶的比例、术中出血量、晶体液输注量、胶体液输注量及术后输血者比例等方面的差异均无统计学意义（P〉0.05）。结论术中给予TXA可能是减少儿童癫痫外科异体输血需求的一项有效措施。

Objective To investigate the effect of tranexamic acid （TXA） in transfusion demand during children epilepsy surgery. Methods This case-control study included 49 children undergoing epilepsy surgery in Xuanwu Hospital of Capital Medical University. Forty-nine children were divided into the transfusion group and the non-transfusion group. The clinical characteristics, conditions during and after operation, and appilication of TXA were compared between the two groups. Results 57.1% （28/49） children were transfused during operation. The appilication of TXA could be protective of non-transfusion during operation, with odds ratio of 0.20 （95%CI 0.04-0.86）. There were no differences between the two groups in age, gender, height, weight, ASA classification, operation time, the proportion of ≥3 lobes resection, the amount of bleeding, crystoloid solution, colloidal solution and the proportion of postoperative transfusion （P 〉 0.05 ）. The hemoglobin, prothrombin time, activated partial thromboplastin time, international normalized ratio and the fibrinogen levels of all children were within the normal range before surgery, and there were no differences between the two groups （P 〉 0.05）. Conclusion Administration of TXA might be effective to reduce transfusion demand during children epilepsy surgery.