这项研究的目的是确定氨甲环酸(TXA)是否可以显着减少区域麻醉下进行的全肩关节置换术(TSA)的围手术期失血量。
我们做了一个随机的,单盲,对照研究。45例患者在区域麻醉下接受TSA治疗袖带撕裂性关节病,肱骨近端骨折,慢性不稳定,原发性骨关节炎,和先前假体的失败。患者被随机分为两组TXA治疗(TXA),用1g静脉注射(IV),或不干预(NTXA)。术后总引流输出,血红蛋白变异,总失血量,血红蛋白丢失,并测量了输血的需要。还评估了疼痛相关变量:通过视觉模拟量表评估术后疼痛,住院疼痛突破,恢复质量,逗留时间,和凝血功能测试。
参与者的平均年龄为76岁,15.6%为男性,82.2%为美国麻醉医师协会(ASA)的身体状态I或II。两组之间在输血方面没有差异,手术时间,麻醉后护理病房(PACU)住院时间和住院时间,QoR-15或术后疼痛。在TXA组中,在每个时间点,在2、24和48小时通过引流输出测量的出血显著较少。Hb变异-TXA:中位数(IQR)-1.4(1.3)g.dL-1与NTXA:-2.2(1.3)g.dL-1;中位数差异:0.80(0.00-1.20);p=0.047。接受TXA治疗的患者的aPTT较低-TXA:中位数(IQR)29.6(14.0)s与NTXA:33(5.8)s;中位数差异:-4.00(-6.50--1.00);p=0.012。
在区域麻醉下,通过引流输出和TSA中Hb下降测得的TXA使用显着减少了失血量。
The purpose of this
study was to determine whether Tranexamic Acid (TXA) can significantly reduce perioperative blood loss in Total Shoulder Arthroplasty (TSA) performed under regional anesthesia.
We performed a randomized, single blinded, controlled
study. Forty-five patients were submitted to TSA under regional anesthesia to treat cuff tear arthropathy, proximal humeral fractures, chronic instability, primary osteoarthrosis, and failures of previous prosthesis. Patients were randomized to either group TXA therapy (TXA), with 1 g intravenous (IV), or no Intervention (NTXA). Postoperative total drain output, hemoglobin variation, total blood loss, hemoglobin loss, and need for transfusion were measured. Pain-related variables were also assessed: postoperative pain assessment by visual analog scale, inpatient pain breakthrough, quality of recovery, length of stay, and coagulation function testing.
Participants presented a mean age of 76 years, 15.6% were male, 82.2% were American Society of Anesthesiologists (ASA) physical status I or II. There were no differences between groups concerning transfusions, operative time, Post-Anesthesia Care Unit (PACU) length of stay and in-hospital stay, and QoR-15 or postoperative pain. Bleeding measured by drain output at 2, 24 and 48 hours was significantly less in the TXA group at each timepoint. There was a difference in Hb variation - TXA: median (IQR) -1.4 (1.3) g.dL-1 vs. NTXA: -2.2 (1.3) g.dL-1; median difference: 0.80 (0.00-1.20); p = 0.047. aPTT was lower in TXA administered patients - TXA: median (IQR) 29.6 (14.0)s vs. NTXA: 33 (5.8)s; difference in medians: -4.00 (-6.50--1.00); p = 0.012.
TXA use significantly decreased blood loss measured by drain output and Hb drop in TSA under regional anesthesia.