氨甲环酸对脑膜瘤切除术患者术中失血及输血需求的影响

Effect of tranexamic acid on intraoperative blood loss and transfusion requirements in patients undergoing excision of meningioma

目的观察氨甲环酸对脑膜瘤切除术患者术中失血及输血需求的影响。方法选择2018年3月至2020年3月于中国科学技术大学附属第一医院行脑膜瘤切除术患者80例为研究对象,采用随机数字表法将患者分为氨甲环酸组和生理盐水组,每组40例。2组患者均在静脉-吸入复合麻醉下行脑膜瘤切除术。氨甲环酸组患者于切皮前20 min静脉输注氨甲环酸20 mg·kg-1作为负荷剂量,然后持续输注氨甲环酸2 mg·kg-1·h-1直至术毕;生理盐水组患者静脉输注等量生理盐水。围术期采用标准化方案输注红细胞,输血指征为血红蛋白水平低于70 g·L-1。患者均由同一神经外科治疗组医生完成脑膜瘤切除术。观察2组患者术中体温、输液量、尿量、手术时间、术中失血量、异体输血情况、术后24 h血红蛋白、术后24 h引流量、肿瘤切除程度(Simpson分级)、术后神经外科重症监护室(NICU)停留时间、术后住院时间、出院时格拉斯哥预后分级及术后深静脉血栓和肺栓塞等并发症发生情况。结果2组患者术中体温、输晶体液量、输胶体液量、尿量、手术时间比较差异无统计学意义(P>0.05)。氨甲环酸组患者术中失血量、异体红细胞输注总量、异体输血率、术后24 h引流量均低于生理盐水组(P<0.05);氨甲环酸组患者术后24 h血红蛋白水平高于生理盐水组(P<0.05)。2组患者术后癫痫发生率、NICU停留时间、术后住院时间、肿瘤切除程度(Simpson分级)、出院时格拉斯哥预后分级比较差异无统计学意义(P>0.05),2组患者术后均未发生深静脉血栓和肺栓塞等并发症。结论氨甲环酸可降低脑膜瘤切除患者的术中失血量和异体输血率,且未增加血栓栓塞事件的发生。

Objective To observe the effect of tranexamic acid on intraoperative blood loss and the need for blood transfusion in patients undergoing meningioma resection.Methods Eighty patients who scheduled for elective excision of meningioma in the First Affiliated Hospital of University of Science and Technology of China from March 2018 to March 2020 were selected as the research subjects.The patients were divided into the tranexamic acid group and normal saline group by using random number table method,with 40 cases in each group.Patients in the both groups underwent meningioma resection under intravenous inhalation combined anesthesia.Twenty minutes before the skin incision,the patients in the tranexamic acid group received an intravenous infusion of tranexamic acid,20 mg·kg-1 as a loading dose,and then the tranexamic acid was continously infused with 2 mg·kg-1·h-1 until the operation was completed;the patients in the normal saline group received the same amount of normal saline intravenously.In the perioperative period,a standardized protocol was used for infusion of red blood cells,and the indication for blood transfusion was that the hemoglobin level was less than 70 g·L-1.All patients were performed with meningioma resection by doctors in the same neurosurgery treatment group.Intraoperative body temperature,fluid volume,urine volume,operative time,intraoperative blood loss,allogeneic blood transfusion,24 h postoperative hemoglobin,24 h postoperative drainage,tumor resection degree(Simpson classification),postoperative neurosurgery intensive care unit(NICU)stay time,postoperative hospital stay,Glasgow prognosis classification at discharge,and postoperative complications such as deep vein thrombosis and pulmonary embolism of patients in the two groups were observed.Results There was no statistically significant difference in intraoperative body temperature,lens fluid volume,colloidal fluid volume,urine volume and operation time of patients between the two groups(P>0.05).Intraoperative blood loss,total allogeneic red blood cell transfusion,allogeneic blood transfusion rate and drainage volume at 24 h after operation in the tranexamic acid group were lower than those in the normal saline group(P<0.05);the hemoglobin level of patients in the tranexamic acid group was higher than that in the saline group at 24 h after surgery(P<0.05).There was no significant difference in the incidence of postoperative epilepsy,the time of NICU stay,the time of postoperative hospital stay,degree of tumor resection(Simpson classification)and Glasgow prognostic classification of patients between the two groups at discharge(P>0.05).There were no complications such as deep vein thrombosis and pulmonary embolism in both groups.Conclusion Tranexamic acid can reduce the intraoperative blood loss and the rate of allogeneic blood transfusion in patients undergoing meningioma resection without increasing the occurr ence of thromboembolic events.