Background: Epistaxis affects much of the population and is a common medical complaint seen across a variety of medical settings. Current standard of care treatment includes a range of options from topical therapy to ...Background: Epistaxis affects much of the population and is a common medical complaint seen across a variety of medical settings. Current standard of care treatment includes a range of options from topical therapy to invasive intranasal device insertion in the absence of on-demand specialist involvement. Aim: The aim of this article is to not only highlight superior outcomes in patients with acute nontraumatic epistaxis that are treated with noninvasive nebulized tranexamic acid instead of more invasive options, but also monetary benefit to the community through reduced costs. Case Presentation: this case report highlights a successful epistaxis resolution with use of tranexamic acid in a 64-year-old female after she was subjected to intranasal device insertion that did not resolve bleeding. Conclusion: Nebulized tranexamic acid is a cost-effective medication that not only reduces rates of recurrence, but it also increases patient satisfaction while minimizing overall healthcare costs, and therefore should be the first choice therapy in uncomplicated epistaxis management.展开更多
目的探讨胸膜腔内局部应用不同剂量氨甲环酸(tranexamic acid,TXA)对胸科手术患者术后总失血量、术后引流量、凝血功能和术后疼痛的影响。方法选取2015年9月至2016年1月首都医科大学附属北京朝阳医院择期行胸腔镜肺叶切除术的患者60例,...目的探讨胸膜腔内局部应用不同剂量氨甲环酸(tranexamic acid,TXA)对胸科手术患者术后总失血量、术后引流量、凝血功能和术后疼痛的影响。方法选取2015年9月至2016年1月首都医科大学附属北京朝阳医院择期行胸腔镜肺叶切除术的患者60例,随机分为2 g TXA组(A组)、3 g TXA组(B组)和对照组(C组)。于淋巴结清扫充分止血后,关胸放置胸腔闭式引流管前,A、B、C 3组分别将2 g TXA溶液、3g TXA溶液、等体积(40 ml)的生理盐水均匀喷洒于胸腔内,随即夹闭胸腔闭式引流管并记录夹闭时间。观察术后1、3、6、12、24 h引流量,计算总失血量,监测患者术前及术后血常规、凝血功能,随访术后第1天疼痛视觉模拟评分(visual analogue score,VAS)及引流管拔除时间和出院时间。结果A组和B组术后各时点的引流量均低于C组,且在术后3 h[A组与C组:(109.75±60.12)ml比(155.25±77.57)ml;B组与C组:(109.50±44.83)ml比(155.25±77.57)ml]和术后24 h[A组与C组:(449.50±98.76)ml比(479.50±142.03)ml;B组与C组:(384.50±81.75)ml比(479.50±142.03)ml]的差异均有统计学意义(P<0.05)。A组和B组的总失血量较C组降低7.9%和15.9%,但差异无统计学意义(P>0.05)。3组术后PLT及凝血功能比较,差异均无统计学意义(P>0.05)。B组的住院时间较A组和C组缩短[(5.05±1.27)d比(5.23±1.42)d,(5.05±1.27)d比(6.10±1.56)d],差异有统计学意义(P<0.05)。所有患者未出现心肌梗死、脑梗死等并发症。结论胸膜腔内局部应用2 g和3 g TXA溶液均可减少胸腔镜肺叶切除术患者术后总失血量及胸腔引流量,缩短住院时间,不增加血栓形成的风险。胸膜腔内局部应用3 g TXA较2 g TXA在减少术后24 h引流量方面有优势,但对于总失血量无明显影响,尚不能证实局部应用TXA存在剂量-反应关系。展开更多
文摘Background: Epistaxis affects much of the population and is a common medical complaint seen across a variety of medical settings. Current standard of care treatment includes a range of options from topical therapy to invasive intranasal device insertion in the absence of on-demand specialist involvement. Aim: The aim of this article is to not only highlight superior outcomes in patients with acute nontraumatic epistaxis that are treated with noninvasive nebulized tranexamic acid instead of more invasive options, but also monetary benefit to the community through reduced costs. Case Presentation: this case report highlights a successful epistaxis resolution with use of tranexamic acid in a 64-year-old female after she was subjected to intranasal device insertion that did not resolve bleeding. Conclusion: Nebulized tranexamic acid is a cost-effective medication that not only reduces rates of recurrence, but it also increases patient satisfaction while minimizing overall healthcare costs, and therefore should be the first choice therapy in uncomplicated epistaxis management.
文摘目的探讨胸膜腔内局部应用不同剂量氨甲环酸(tranexamic acid,TXA)对胸科手术患者术后总失血量、术后引流量、凝血功能和术后疼痛的影响。方法选取2015年9月至2016年1月首都医科大学附属北京朝阳医院择期行胸腔镜肺叶切除术的患者60例,随机分为2 g TXA组(A组)、3 g TXA组(B组)和对照组(C组)。于淋巴结清扫充分止血后,关胸放置胸腔闭式引流管前,A、B、C 3组分别将2 g TXA溶液、3g TXA溶液、等体积(40 ml)的生理盐水均匀喷洒于胸腔内,随即夹闭胸腔闭式引流管并记录夹闭时间。观察术后1、3、6、12、24 h引流量,计算总失血量,监测患者术前及术后血常规、凝血功能,随访术后第1天疼痛视觉模拟评分(visual analogue score,VAS)及引流管拔除时间和出院时间。结果A组和B组术后各时点的引流量均低于C组,且在术后3 h[A组与C组:(109.75±60.12)ml比(155.25±77.57)ml;B组与C组:(109.50±44.83)ml比(155.25±77.57)ml]和术后24 h[A组与C组:(449.50±98.76)ml比(479.50±142.03)ml;B组与C组:(384.50±81.75)ml比(479.50±142.03)ml]的差异均有统计学意义(P<0.05)。A组和B组的总失血量较C组降低7.9%和15.9%,但差异无统计学意义(P>0.05)。3组术后PLT及凝血功能比较,差异均无统计学意义(P>0.05)。B组的住院时间较A组和C组缩短[(5.05±1.27)d比(5.23±1.42)d,(5.05±1.27)d比(6.10±1.56)d],差异有统计学意义(P<0.05)。所有患者未出现心肌梗死、脑梗死等并发症。结论胸膜腔内局部应用2 g和3 g TXA溶液均可减少胸腔镜肺叶切除术患者术后总失血量及胸腔引流量,缩短住院时间,不增加血栓形成的风险。胸膜腔内局部应用3 g TXA较2 g TXA在减少术后24 h引流量方面有优势,但对于总失血量无明显影响,尚不能证实局部应用TXA存在剂量-反应关系。
