氨甲环酸对颅缝早闭患儿颅骨重塑术围手术期出血影响的初步观察

Preliminary study of the effect of tranexamic acid on perioperative hemorrhage of cranioplasty for craniosynostosis

目的探讨氨甲环酸(TXA)应用于颅缝早闭患儿颅骨重塑术对围手术期出血的影响。方法回顾性分析复旦大学附属儿科医院2015年2月至2018年10月接受颅骨重塑术的患儿临床资料。将患儿分为两组:术中应用TXA者归入TXA组;未应用TXA者归入对照组。观察术中出血量、输血量,术后输血量、引流量,以及术后血红蛋白和凝血功能指标变化。计量资料用M(Q1,Q3)描述,采用Mann-WhitneyU检验进行比较。结果共纳入41例患儿,其中TXA组26例,男18例,女8例,年龄9.5(7.0,38.8)个月;对照组15例,男10例,女5例,年龄9.2(6.6,18.3)个月。结果显示,两组患者术前血红蛋白水平的差异无统计学意义(P>0.05);TXA组术后即刻及术后24 h、72 h的血红蛋白水平均高于对照组(P<0.05)。TXA组术中总出血量及公斤体质量出血量均少于对照组[150.0(57.5,225.0)ml vs.200.0(80.0,300.0)ml,P<0.05;13.6(6.8,18.5)ml/kg vs.15.8(7.0,27.0)ml/kg,P<0.01]。TXA组术中的公斤体质量输血量少于对照组[15.0(8.8,17.7)ml/kg vs.17.1(13.0,23.3)ml/kg,P<0.05]。两组术后的总输血量、公斤体质量输血量以及总引流量、公斤体质量引流量的差异均无统计学意义(P>0.05)。两组患儿手术前、后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和纤维蛋白原的差异均无统计学意义(P>0.05)。结论在颅缝早闭患儿行颅骨重塑手术中应用TXA可减少出血及输血量。

Objective To investigate the effect of tranexamic acid on perioperative hemorrhage of cranioplasty for craniosynostosis.Methods A retrospective analysis was performed on the clinical data of children who received cranial remodeling from the Children’s Hospital of Fudan University from February 2015 to October 2018.The patients were divided into two groups:tranexamic acid treatment group(TXA group)and no tranexamic acid treatment group(control group).The average intraoperative blood loss,the average amount of blood transfusion,postoperative average amount of blood transfusion,average drainage volume,and changes of postoperative hemoglobin and blood coagulation function were observed.The measurement data were described by M(Q1,Q3)and analyzed with Mann-Whitney U test.Results A total of 41 patients were included in this study.There were 26 patients in TXA group,18 males and 8 females,aged 9.5(7.0,38.8)months;in the control group,there were 15 patients,10 males and 5 females,aged 9.2(6.6,18.3)months.The results showed that there was no significant difference in preoperative hemoglobin level between the two groups(P>0.05).The hemoglobin level of TXA group was higher than that of control group immediately after operation and 24 h and 72 h after operation(P<0.05).Total intraoperative blood loss and blood loss per kilogram of body weight in TXA group were lower than those in control group[150.0(57.5,225.0)ml vs.200.0(80.0,300.0)ml,P<0.05;13.6(6.8,18.5)ml/kg vs.15.8(7.0,27.0)ml/kg,P<0.01].The amount of intraoperative transfusion volume per kilogram of body weight in TXA group was less than that in control group[15.0(8.8,17.7)ml/kg vs.17.1(13.0,23.3)ml/kg,P<0.05].There were no significant differences between the two groups in postoperative total transfusion volume,transfusion volume per kilogram of body weight,total drainage volume and drainage volume per kilogram of body weight(P>0.05).There was no significant difference in prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen between the two groups before and after surgery(P<0.05).Conclusion TXA can reduce the amount of blood loss and blood transfusion in craniosynostosis in children.