氨甲环酸在创伤出血患者中的应用

Application of Tranexamic Acid in Patients with Trauma-Related Hemorrhage

目的总结创伤性凝血病以及氨甲环酸在创伤出血患者中的应用情况。方法复习近年国内外的相关文献,对创伤性凝血病的定义及发病机制,以及氨甲环酸对于创伤出血患者的应用情况进行综述。结果创伤性凝血病即为创伤后早期出现的凝血功能紊乱,目前多认为其与抗凝和纤维蛋白溶解活性增强有关。氨甲环酸作为一种抗纤维蛋白溶解药物,其在临床多个领域中使用均取得了良好的效果。氨甲环酸对创伤后早期(伤后3 h内)应用可以降低创伤出血所致的死亡率,且在伤后1 h内使用效果最明显,而>3 h使用则无效甚至会增加出血所致的死亡风险。目前关于氨甲环酸的剂量范围变化较大,但不同剂量的氨甲环酸对于患者失血量和输血量并没有显示出差别,但在长时间或大剂量使用时有增加血栓形成的可能或成为癫痫发生率增高的重要危险因素之一。结论急诊创伤患者面临一系列创伤相关的死亡威胁,恰当而及时地止血对预后有重要意义,创伤后早期、短程、合适剂量地使用氨甲环酸能显著减少死亡及不良事件的发生,但其使用时机及剂量还需要进一步优化。

Objective To review trauma-induced coagulopathy and use of tranexamic acid in patients with traumatic hemorrhage. Methods The relevant literatures about the definition and pathogenesis of trauma-induced coagulopathy, and the use of tranexamic acid in patients with traumatic hemorrhage were reviewed. Results Traumaticinduced coagulopathy was a coagulation disorder in the early stage after injury, which was associated with the anticoagulation and increasing activity of fibrinolysis. Tranexamic acid as an anti-fibrinolytic drug, it had a good result in clinical application, which could reduce the mortality due to bleeding in use within 3 h after injury, the effect was the best in use within 1 h after injury, but it had no benefit or even would increase the mortality due to hemorrhage in use 〉3 h after injury. There was no standardized dosage of tranexamic acid, but the volumes of blood loss and blood transfusion had no difference under the different dosages. However, high dosage or long-term use of tranexamic acid might increase the risk of the thrombosis or epilepsy. Conclusions Emergency traumatic patients face a series of death threats related trauma. Appropriate and timely hemostasis is important for prognosis. Early, short-term, and appropriate dosage of tranexamic acid could obviously reduce mortality and adverse events, but its timing and dosages need to be further optimized.