Abstract：
Craniosynostosis is a congenital condition characterized by the premature closure of one or more sutures in the skull after birth, often necessitating urgent surgical intervention. Nevertheless, cranial vault reconstruction surgery can cause rapid and massive blood loss. This procedure requires a blood transfusion, which entails potential hazards. In addition, the hemostatic system in children differs significantly from that in adults, resulting in increased bleeding during surgical procedures. We conducted a comprehensive literature review in the PubMed, Scopus, and Web of Science databases, referring to their inception for studies on the use of tranexamic acid in pediatric craniosynostosis surgery. Selection criteria were based on the relevance of tranexamic acid, its clinical efficacy, and its safety profile in pediatric populations. Authoritative reviews were considered to ensure a comprehensive synthesis of current knowledge and practice trends in the field. We determined that a low loading dose of 10 mg/kg followed by a maintenance dose of 5 mg/kg/h is as effective as a high dose of 50 mg/kg followed by a maintenance dose of 10 mg/kg/h of tranexamic acid when administered after induction of anesthesia through skin closure and can reduce blood loss by up to 72% and total packed red blood cell transfusion by up to 85%. No difference in safety profile is observed. We concluded that a low dose of tranexamic acid, administered as a loading dose followed by a maintenance dose, is beneficial and safe for reducing blood loss and transfusion following craniosynostosis surgery.
摘要：
颅骨融合是一种先天性疾病，其特征是出生后颅骨中的一条或多条缝线过早闭合，通常需要紧急手术干预。然而，颅骨重建手术会导致快速大量的失血。这个手术需要输血,这带来了潜在的危险。此外,儿童的止血系统与成人有很大不同，导致手术过程中出血增加。我们在PubMed上进行了全面的文献综述，Scopus,和WebofScience数据库,提到他们开始研究氨甲环酸在小儿颅骨前突手术中的应用。选择标准基于氨甲环酸的相关性，其临床疗效,及其在儿科人群中的安全性。考虑了权威性审查，以确保对该领域当前的知识和实践趋势进行全面综合。我们确定，低负荷剂量为10mg/kg，然后维持剂量为5mg/kg/h，与高剂量为50mg/kg，然后维持剂量为10mg/kg/h的氨甲环酸一样有效。在通过皮肤闭合诱导麻醉后给药，可以减少多达72％的失血量和多达85％的总红细胞输注。在安全性方面没有观察到差异。我们的结论是低剂量的氨甲环酸,作为负荷剂量给药，然后是维持剂量，对于减少颅骨融合手术后的失血和输血是有益和安全的。
