氨甲环酸在脊柱手术中的应用及研究进展

中国临床药理学与治疗学 ›› 2015, Vol. 20 ›› Issue (1): 96-100.

氨甲环酸在脊柱手术中的应用及研究进展

刘延军, 顾小萍, 马正良

南京大学医学院附属鼓楼医院麻醉科,南京 210008,江苏

收稿日期:2014-04-29 修回日期:2014-10-27 发布日期:2020-07-20
通讯作者: 顾小萍,通信作者,女,博士,教授,主任医师,博士生导师,研究方向:围术期血液保护。Tel:025-83304616 E-mail:13813996903@126.com
作者简介:刘延军,男,硕士研究生,研究方向:围术期血液保护。Tel:18205188607 E-mail:yanjiu_liu2006@163.com
基金资助:
江苏省医学重点人才(RC2011006);江苏省医学重点学科(XK201140)

Administration and research progress of tranexamic acid in patients undergoing major spine surgery

LIU Yan-jun, GU Xiao-ping, MA Zheng-liang

Department of Anesthesiology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu, China

Received:2014-04-29 Revised:2014-10-27 Published:2020-07-20

摘要/Abstract

摘要： 行脊柱侧凸矫形手术的患者常因术中大出血而需输血。虽然近年来血液制品的安全性得到显著提高,但仍存在感染性和非感染性风险。且输血与患者发病率和死亡率之间存在紧密联系。因此围术期常采用许多措施如抗纤溶药物来减少脊柱矫形手术过程的出血量,从而降低输血需求。由于抑肽酶可能会增加肾功能不全、心血管不良事件、肺栓塞等并发症的发生率,FDA于2007年11月宣布暂停使用抑肽酶。目前临床常用的抗纤溶药物是赖氨酸类似物——氨甲环酸。脊柱侧凸矫形手术中使用氨甲环酸,一方面可以减少患者出血量,保护血液,避免因输血而造成患者住院费用的增加;另一方面术后患者未出现如癫痫等神经系统并发症,也未增加静脉血栓发生率。本综述旨在探讨氨甲环酸脊柱手术的应用及研究进展。

关键词: 氨甲环酸, 脊柱侧凸, 输血, 不良事件

Abstract: The patients undergoing scoliosis correction surgery are always associated with considerable blood loss, and thus requiring transfusion. The safety of the blood supply has been greatly improved in recent years. However, the risk of infection and noninfectious complications still exist to the patients. It is shown that connection between transfusion and morbidity and mortality is significantly tight. Thus, rigorous efforts including antifibrinolytic agents have been made to surgical bleeding and the need for blood product transfusion in the surgical correction of scoliosis.Since aprotinin can increase the risk of intraoperative renal dysfunction, cardiovascular events and pulmonary embolism, the US Food and Drug Administration (FDA) suspend aprotinin from the market in November 2007. At present, the most commonly used antifibrinolytic drug is the tranexamic acid (TXA), which is a lysine analog. The use of tranexamic acid in the surgical correction of scoliosis, one hand, can reduce the perioperative blood loss, help the blood conservation, and avoid the increasement of hospitalization costs due to transfusion; the other hand, use of tranexamic acid can also reduce the risk of neurological adverse events such as convulsive seizures during postoperative period; and also decrease the incidence of venous thrombosis. The objective of this review is to discuss the administration and to assess the research progress of tranexamic acid in patients undergoing major spine surgery.

Key words: tranexamic acid, scoliosis, blood transfusion, adverse events

中图分类号:

R614

刘延军, 顾小萍, 马正良. 氨甲环酸在脊柱手术中的应用及研究进展[J]. 中国临床药理学与治疗学, 2015, 20(1): 96-100.

LIU Yan-jun, GU Xiao-ping, MA Zheng-liang. Administration and research progress of tranexamic acid in patients undergoing major spine surgery[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2015, 20(1): 96-100.

参考文献

[1] Cardone D, Klein AA. Perioperative blood conservation[J]. Eur J Anaesthesiol, 2009, 26(9): 722-729.
[2] Cooper JR, Abrams J, Frazier OH, et al. Fatal pulmonary microthrombi during surgical therapy for end-stage heart failure: possible association with antifibrinolytic therapy[J]. J Thorac Cardiovasc Surg, 2006, 131(5): 963-968.
[3] Mangano DT, Miao Y, Vuylsteke A, et al. Mortality associated with aprotinin during 5 years following coronary artery bypass graft surgery[J]. JAMA, 2007, 297(5): 471-479.
[4] McCormack PL. Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis[J]. Drugs, 2012, 72(5): 585-617.
[5] Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications[J]. Drugs,1999, 57(6): 1005-1032.
[6] Shapiro F, Zurakowski D, Sethna NF. Tranexamic acid diminishes intraoperative blood loss and transfusion in spinal fusions for Duchenne muscular dystrophy scoliosis[J]. Spine (Phila Pa 1976), 2007, 32(20): 2278-2283.
[7] Pfizer. Cyklokapron^®(tranexamic acid injection): US prescribing information[online]. Available from URL: http://labeling.pfizer.com/ShowLabeling.aspx?id=556[Accessed 2012 Feb 23].
[8] Ferring Pharmaceuticals Inc. Lysteda (tranexamic acid) tablets: US prescribing information[online]. Available from URL: http://lysteda.com/assets/pdf/PI_FERRING2010.pdf[Accessed 2012 Feb 23].
[9] Dirkmann D, Gorlinger K, Gisbertz C, et al. Factor XIII and tranexamic acid but not recombinant factor VIIa attenuate tissue plasminogen activator-induced hyperfibrinolysis in human whole blood[J]. Anesth Analg, 2011,114(6): 1182-1188.
[10] Benoni G, Björkman S, Fredin H. Application of pharmacokinetic data from healthy volunteers for the prediction of plasma concentrations of tranexamic acid in surgical patients[J]. Clin Drug Invest, 1995, 10(5): 280-287.
[11] Fiechtner BK, Nuttall GA, Johnson ME, et al. Plasma tranexamic acid concentrations during cardiopulmonary bypass[J]. Anesth Analg, 2001, 92(5): 1131-1136.
[12] Spahn DR, Bouillon B, Cerny V, et al. Management of bleeding and coagulopathy following major trauma: an updated European guideline[J]. Crit Care, 2013, 17(2): R76.
[13] Elwatidy S, Jamjoom Z, Elgamal E, et al. Efficacy and safety of prophylactic large dose of tranexamic acidin spine surgery: a prospective, randomized, double-blind, placebo-controlled study[J]. Spine (Phila Pa 1976), 2008, 33(24): 2577-2580.
[14] Lykissas MG, Crawford AH, Chan G, et al. The effect of tranexamic acid in blood loss and transfusion volume in adolescent idiopathic scoliosis surgery: a single-surgeon experience[J]. J Child Orthop, 2013, 7(3): 245-249.
[15] Grant JA, Howard J, Luntley J, et al. Perioperative blood transfusion requirements in pediatric scoliosis surgery: the efficacy of tranexamic acid[J]. J Pediatr Orthop, 2009, 29(3): 300-304.
[16] Andersson L, Nilsoon IM, Colleen S, et al. Role of urokinase and tissue activator in sustaining bleeding and the management thereof with EACA and AMCA[J]. Ann N Y Acad Sci, 1968, 146(2): 642-656.
[17] Yee BE, Wissler RN, Zanghi CN, et al. The effective concentration of tranexamic acid for inhibition of fibrinolysis in neonatal plasma in vitro[J]. Anesth Analg, 2013, 117(4): 767-772.
[18] Benoni G, Lethagen S, Fredin H. The effect of tranexamic acid on local and plasma fibrinolysis during total knee arthroplasty[J]. Thromb Res, 1997, 85(3): 195-206.
[19] Kalavrouziotis D, Voisine P, Mohammadi S, et al. High-dose tranexamic acid is an independent predictor of early seizure after cardiopulmonary bypass[J]. Ann Thor Surg, 2012, 93(1): 148-154.
[20] Murkin JM, Falter F, Granton J, et al. High-dose tranexamic acid is associated with nonischemic clinical seizures in cardiac surgical patients[J]. Anesth Analg,2010,110(2): 350-353.
[21] Koster A, Börgermann J, Zittermann A, et al. Moderate dosage of tranexamic acid during cardiac surgery with cardiopulmonary bypass and convulsive seizures: incidence and clinical outcome[J]. Br J Anaesth, 2013, 110(1): 34-40.
[22] Breuer T, Martin K, Wilhelm M, et al. The blood sparing effect and the safety of aprotinin compared to tranexamic acid in paediatric cardiac surgery[J]. Eur J Cardiothorac Surg, 2009, 35(1): 167-171.
[23] Tretiak R, Laupacis A, Riviere M, et al. Cost of allogeneic and autologous blood transfusion in Canada. Canadian Cost of Transfusion Study Group[J]. Can Med Assoc J,1996,154(10): 1501-1508.
[24] Guerriero C, Cairns J, Perel P, et al. Cost-effectiveness analysis of administering tranexamic acid to bleeding trauma patients using evidence from the CRASH-2 trial[J]. PLoS One, 2011, 6(5): e18987.