背景:眼睑手术是五大美学程序之一。它的执行是为了改善外观和功能,但是术中出血会导致不良事件困扰患者。这项研究的目的是证明TXA联合肾上腺素在减少术中失血量和术后炎症中的作用。
方法:这项前瞻性随机对照试验是对15例接受上眼睑成形术的患者的30个眼睑进行的。每位患者的一只眼睛被随机分配到TXA组,另一只眼睛在对照组。TXA组的眼睛皮下给予2%利多卡因与肾上腺素(1:100000)和TXA(50mg/ml)以1:1的混合物作为局部麻醉剂。对照组的眼睛接受2%利多卡因和肾上腺素(1:100000),用生理盐水以1:1的混合物稀释。比较两组患者术中出血量及术后肿胀情况。
结果:TXA组[4.86(1.83)ml]的术中失血量明显高于对照组[2.53(1.49)ml](p<0.001)。两组手术时间差异无统计学意义(p=0.645)。疼痛评分(p=0.498),眼睑折痕(p=0.548),或MRD1(p=0.626)。术后第7天,眼睑折痕无差异(p=0.879),MRD1(p=0.463),疼痛评分(p=0.934),或瘀斑(p=0.976)在两组之间。
结论:与利多卡因单独使用肾上腺素相比,利多卡因与肾上腺素联合使用会增加术中出血,但术后肿胀或瘀斑没有差异。在获得其他相关数据之前,应避免皮下注射TXA联合利多卡因和肾上腺素。需要进一步的药物相互作用研究。
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BACKGROUND: Eyelid surgery is one of the top five aesthetic procedures. It is performed to improve both appearance and function, but intraoperative bleeding leads to adverse events which perturb patients. The objective of this
study was to demonstrate the efficacy of TXA combined with epinephrine in decreasing intraoperative blood loss and postoperative inflammation.
METHODS: This prospective randomized control
trial was performed on the 30 eyelids of 15 patients who underwent upper blepharoplasty. One of each patient\'s eyes was randomly assigned to the TXA group, and the other eye was in the control group. Eyes in the TXA group were given 2% lidocaine with epinephrine (1:100000) mixed with TXA (50 mg/ml) in 1:1 mixture subcutaneously as a local anesthetic. The eyes in the control group received 2% lidocaine with epinephrine (1:100000) diluted with normal saline in 1:1 mixture. Intraoperative blood loss and postoperative swelling were compared between the two groups.
RESULTS: Intraoperative blood loss was significantly higher in the TXA group [4.86 (1.83) ml] than it was in the control group [2.53 (1.49) ml] (p < 0.001). There was no statistically significant difference between the two groups in operative time (p = 0.645), pain score (p = 0.498), lid crease (p = 0.548), or MRD1 (p = 0.626). On postoperative day 7, there was no difference in lid crease (p = 0.879), MRD1 (p = 0.463), pain score (p = 0.934), or ecchymosis (p = 0.976) between two groups.
CONCLUSIONS: TXA in lidocaine with epinephrine was found to increase intraoperative bleeding compared to lidocaine with epinephrine alone, but there was no difference in postoperative swelling or ecchymosis. TXA combined with lidocaine and epinephrine injected subcutaneously should be avoided until additional relevant data are obtained. Further drug interaction
study is needed.
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