氨甲环酸(TXA)是一种抗纤维蛋白溶解剂,可在多种手术中减少失血量和死亡率。包括脊柱手术,创伤性脑损伤,和颅骨融合症.尽管使用广泛,TXA在脊柱手术中的安全性和有效性被认为是有争议的,因为文献相对缺乏,而且在报道的研究中缺乏统计学功效.然而,如果可以证明TXA可以减少椎板切除术中的失血,融合和后路器械,更多的外科医生可能会将其包含在他们的医疗设备中。作者旨在对TXA在椎板切除术和后路植骨融合术中减少失血的功效进行最新的系统评价和荟萃分析。
系统评价和荟萃分析,遵守PRISMA准则,是通过搜索PubMed的数据库来执行的,WebofScience,还有Cochrane.在这些平台上查询了所有报告TXA在椎板切除术和后部器械融合中使用的研究。检索到的变量包括患者人口统计,手术适应症,涉及脊髓水平,椎板切除术的类型,TXA给药剂量,TXA给药途径,手术持续时间,失血,输血率,术后血红蛋白水平,围手术期并发症。使用卡方检验评估了不同研究的异质性,Cochran的Q测试,用R统计编程软件进行I2检验。
共有7篇文章被纳入定性研究,其中6篇以411例患者为特征的文章进行了统计分析。TXA最常见的给药途径是静脉内给药,术前给药15mg/kg。手术开始后,TXA给药模式在研究中有所不同。与TXA队列相比,非TXA队列的输血量增加。给予TXA的患者显示失血量显著减少(平均差异-218.44mL;95%CI-379.34至-57.53;p=0.018)。TXA给药与手术持续时间的统计学显着减少无关。TXA或非TXA患者队列均未报告不良事件。
TXA能显著减少宫颈围手术期失血量,胸廓,腰椎椎板切除术和融合手术,同时显示最小的并发症。
Tranexamic acid (TXA) is an antifibrinolytic agent associated with reduced blood loss and mortality in a wide range of procedures, including spine surgery, traumatic brain injury, and craniosynostosis. Despite this wide use, the safety and efficacy of TXA in spine surgery has been considered controversial due to a relative scarcity of literature and lack of statistical power in reported studies. However, if TXA can be shown to reduce blood loss in laminectomy with fusion and posterior instrumentation, more surgeons may include it in their armamentarium. The authors aimed to conduct an up-to-date systematic
review and meta-analysis of the efficacy of TXA in reducing blood loss in laminectomy and fusion with posterior instrumentation.
A systematic
review and meta-analysis, abiding by PRISMA guidelines, was performed by searching the databases of PubMed, Web of Science, and Cochrane. These platforms were queried for all studies reporting the use of TXA in laminectomy and fusion with posterior instrumentation. Variables retrieved included patient demographics, surgical indications, involved spinal levels, type of laminectomy performed, TXA administration dose, TXA route of administration, operative duration, blood loss, blood transfusion rate, postoperative hemoglobin level, and perioperative complications. Heterogeneity across studies was evaluated using a chi-square test, Cochran\'s Q test, and I2 test performed with R statistical programming software.
A total of 7 articles were included in the qualitative study, while 6 articles featuring 411 patients underwent statistical analysis. The most common route of administration for TXA was intravenous with 15 mg/kg administered preoperatively. After the beginning of surgery, TXA administration patterns were varied among studies. Blood transfusions were increased in non-TXA cohorts compared to TXA cohorts. Patients administered TXA demonstrated a significant reduction in blood loss (mean difference -218.44 mL; 95% CI -379.34 to -57.53; p = 0.018). TXA administration was not associated with statistically significant reductions in operative durations. There were no adverse events reported in either the TXA or non-TXA patient cohorts.
TXA can significantly reduce perioperative blood loss in cervical, thoracic, and lumbar laminectomy and fusion procedures, while demonstrating a minimal complication profile.