氨甲环酸对软骨毒性的研究进展

Research progress regarding the toxicity of tranexamic acid to cartilage

背景:氨甲环酸作为止血药物已被广泛应用于骨科手术中,但是关节镜手术后使用会将软骨、肌腱和韧带直接暴露于氨甲环酸中,有必要再次重申软骨的重要性。目的:通过目前已有的实验研究和临床资料分析局部应用氨甲环酸对软骨的影响。方法:通过计算机检索中国知网、万方医学网、PubMed数据库中的相关文献,检索时间从建库截至2020-02-10,检索中文主题词为"氨甲环酸、关节镜、软骨、毒性",英文主题词为"tranexamic acid,cartilage,arthroscopy,toxicity"。结果与结论:临床氨甲环酸的使用剂量仍以医师经验为主,关于其安全给药浓度及暴露时间存在很大争议,缺乏精确的临床指南。基于目前已有的体外实验,发现在25-50g/L之间应该存在一个对软骨生物活性最安全的最高质量浓度。在有更进一步的临床证据之前,应当建议在局部应用氨甲环酸时应使用质量浓度不超过25 g/L。使用氨甲环酸进行冲洗时的质量浓度不宜超过70 g/L。关于局部应用氨甲环酸最恰当的质量浓度仍需进一步的研究及临床试验,以便更好地阐明其在局部使用中的安全性。

BACKGROUND: Tranexamic acid has been widely used in orthopedic surgery as a hemostatic drug. However, after arthroscopic surgery, the cartilage, tendons and ligaments are directly exposed to tranexamic acid. It is necessary to reiterate the importance of cartilage again. OBJECTIVE: To analyze the effect of topical tranexamic acid on cartilage through the existing experimental research and clinical data. METHODS: Related documents were searched in CNKI, WANFANG MED ONLINE, and PubMed by computer. The retrieval time was from the inception of the database to February 10, 2020. The Chinese and English key words were "tranexamic acid, arthroscopy, cartilage, toxicity". RESULTS AND CONCLUSION: The dosage of clinical tranexamic acid is still based on the experience of physicians. There is great controversy regarding its safe administration concentration and exposure time. There is a lack of precise clinical guidelines. Based on the existing in vitro experiments, it was found that between 25-50 g/L, there should be a concentration that is safest for cartilage biological activity. Before there are further clinical evidences, it should be recommended that the local concentration of tranexamic acid should not exceed 25 g/L. When using tranexamic acid for washing, the mass concentration should not exceed 70 g/L. Regarding the most appropriate mass concentration of tranexamic acid for topical application, further research and clinical trials are still needed to better clarify its safety in topical use.