氨甲环酸在颅脑创伤患者院前急救中的应用效果分析

Analysis of the Effect of Tranexamic Acid in Pre-hospital Emergency Treatment of Patients with Craniocerebral Trauma

目的 探讨氨甲环酸在颅脑创伤患者院前急救中的应用效果。方法 选取2018年1月—2021年6月上海交通大学医学院附属苏州九龙医院收治的80例颅脑创伤患者作为研究对象,用随机数表法将其分对照组和观察组,各40例。两组患者均给予常规现场救治,止血并建立静脉通道,开放气道。观察组在常规现场救治基础上加用氨甲环酸。比较两组患者24 h后CT检查结果、手术干预及血肿缩小率、患者ICU时间和出院3个月的GOS评分。结果 观察组出血量(3.32±0.92)mL低于对照组(8.35±3.35)mL,差异有统计学意义(t=9.157,P<0.001);观察组脑组织压迫发生率(2.50%)和迟发性颅内血肿发生率(7.50%)低于对照组(22.50%、30.00%),差异有统计学意义(χ^(2)=7.314、6.646,P<0.05);观察组手术干预率(5.00%)低于对照组(27.50%),血肿缩小率(85.00%)高于对照组(52.50%),差异有统计学意义(χ^(2)=7.440、9.833,P<0.05);观察组ICU时间(2.81±0.80)d短于对照组(5.52±1.51)d,出院后3个月时观察组GOS评分(3.75±0.85)分高于对照组(3.01±0.93)分,差异有统计学意义(t=10.030、3.715,P<0.001)。结论 颅脑创伤患者在院前急救阶段给予氨甲环酸药物,可缩小血肿体积并降低再次出血发生率,改善疾病预后。

Objective To explore the effect of tranexamic acid in pre-hospital emergency care for patients with craniocerebral trauma.Methods 80 cases of craniocerebral trauma patients admitted to Suzhou Jiulong Hospital affiliated to Shanghai Jiaotong University,School of Medicine from January 2018 to June 2021 were selected as study subjects.They were divided into control group and observation group used the random number table method,with 40 cases in each.Both groups were given conventional on-site treatment to stop bleeding and establish intravenous access and open the airway.In the observation group,tranexamic acid was added to the conventional on-site treatment.The CT findings after 24 h,surgical intervention and hematoma reduction rate,ICU time of patients and GOS score at 3months from discharge between the two groups.Results The amount of bleeding in the observation group was (3.32±0.92) mL,which was lower than that in the control group (8.35±3.35) mL,the difference was statistically significant (t=9.157,P<0.001).The incidence of brain tissue compression (2.50%) and delayed intracranial hemorrhage (7.50%) in the observation group was lower than those in the control group (22.50%,30.00%),the difference was statistically significant (χ^(2)=7.314,6.646,P<0.05).The surgical intervention rate (5.00%) in the observation group was lower than that in the control group (27.50%),the hematoma reduction rate (85.00%) in the observation group was higher than that in the control group (52.50%),the difference was statistically significant (χ^(2)=7.440,9.833,P<0.05).The ICU time in the observation group (2.81±0.80) d was shorter than that in the control group (5.52±1.51) d,the GOS score in the observation group (3.75±0.85) points was higher than that in the control group (3.01±0.93) points at 3 months after discharge,the difference was statistically significant (t=10.030,3.715,P<0.001).Conclusion Tranexamic acid given to patients with craniocerebral trauma during the prehospital emergency phase can reduce the volume of hematoma and the incidence of rebleeding,and improve disease prognosis.