PDF(Pubmed)
Abstract：
Craniosynostosis, the premature fusion of skull sutures in children, requires surgical correction. This procedure routinely requires allogeneic blood transfusions, which are associated with multiple risks of their own. Since 2008, antifibrinolytics tranexamic acid (TXA) and epsilon aminocaproic acid (EACA or Amicar) have been widely used. There is literature comparing the two agents in scoliosis and cardiothoracic surgery, but the literature comparing the two agents in pediatric craniofacial surgery (CF) is limited. Tranexamic acid use is more common in pediatric CF surgery and has been thoroughly studied; however, it costs about three times as much as EACA and has been associated with seizures. This study compiles the literature assessing the safety and efficacy of EACA in reducing blood loss and transfusion volumes in children and explores its potential use in pediatric CF surgery. Papers from 2000 to 2021 regarding the effectiveness and safety of EACA in Pediatric scoliosis, cardiothoracic, and craniosynostosis surgery were reviewed and compiled. Papers were found via searching PubMed and Cochrane databases with the key terms: Epsilon aminocaproic acid, EACA, Amicar, Tranexamic acid, TXA, craniosynostosis, scoliosis, cardiothoracic, and pediatric. Prospective studies, retrospective studies, and meta-analyses were included. Twenty-nine papers were identified as pertinent from the literature searched. Four were meta-analyses, 14 were retrospective, and 11 were prospective. Of these papers, seven were of cardiac surgery, 12 were of scoliosis, and nine were of craniosynostosis. During our search, EACA has been shown to consistently reduce blood transfusion volumes compared to control. However, it is not as effective when compared to TXA. EACA has a similar safety profile to TXA but has a reduced risk of seizures. There are not many studies of EACA in craniosynostosis repair, but the existing literature shows promising results for EACA\'s efficacy and safety, warranting more studies.
摘要：
颅骨融合症,儿童颅骨缝线过早融合,需要手术矫正.这个手术通常需要异体输血,这与他们自己的多种风险有关。自2008年以来，抗纤维蛋白溶解剂氨甲环酸（TXA）和ε氨基己酸（EACA或Amicar）已被广泛使用。有文献比较两种药物在脊柱侧凸和心胸外科手术中的应用，但是在小儿颅面外科（CF）中比较两种药物的文献有限。氨甲环酸的使用在小儿CF手术中更为常见，并且已经进行了彻底的研究；但是，它的成本约为EACA的三倍，并且与癫痫发作有关。这项研究汇编了评估EACA在减少儿童失血和输血量方面的安全性和有效性的文献，并探讨了其在小儿CF手术中的潜在用途。2000年至2021年关于EACA在小儿脊柱侧凸中的有效性和安全性的论文，心胸,并对颅骨融合手术进行了回顾和汇编。论文是通过搜索PubMed和Cochrane数据库找到的，其关键术语为：Epsilon氨基己酸，EACA,Amicar,氨甲环酸,TXA,颅骨融合症,脊柱侧弯,心胸,和儿科。前瞻性研究,回顾性研究,并纳入荟萃分析。从检索的文献中确定了29篇论文。四个是荟萃分析，14是回顾性的，和11个是前瞻性的。在这些文件中，七个是心脏手术，12人是脊柱侧弯,九人是颅骨融合症。在我们的搜索过程中,与对照相比,EACA已显示一致地减少输血量。然而,与TXA相比，效果不佳。EACA具有与TXA相似的安全性，但癫痫发作的风险降低。EACA在颅骨融合修复中的研究并不多，但现有文献显示，EACA的疗效和安全性有希望的结果，保证更多的研究。
