氨甲环酸用于脊柱手术中的研究进展_West China Medical Journal

Authors：

 陈硕 ¹ ,  蒋电明 ²

1. ;
2. ;

Corresponding author：

蒋电明, Email: jdm571026@vip.163.com

Keywords：

氨甲环酸; 脊柱手术; 研究进展

DOI：

10.7507/1002-0179.201600214

Video：

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骨科大手术常常伴随大量失血及术中术后的输血治疗。而输血存在诸多风险，如发热、感染、输血反应、输血相关传染病等。最近的十多年时间里，氨甲环酸作为一种围手术期止血及减少输血的药物得到广泛应用。综合国外有关氨甲环酸在脊柱手术中应用的文献可以发现，氨甲环酸可有效降低围手术期的失血和输血，降低住院费用，减少住院时间，同时并未增加血栓等并发症的发生率。但在脊柱手术中氨甲环酸使用的最佳剂量、给药方式及使用时间尚无定论，需进一步研究。

Citation： 陈硕, 蒋电明. 氨甲环酸用于脊柱手术中的研究进展. West China Medical Journal, 2016, 31(4): 784-788. doi: 10.7507/1002-0179.201600214 Copy

1.	Lin ZX, Woolf SK. Safety, efficacy, and cost-effectiveness of tranexamic acid in orthopedic surgery[J]. Orthopedics, 2016, 39(2): 119-130.
2.	Ng BK, Chau WW, Hung AL, et al. Use of tranexamic acid (TXA) on reducing blood loss during scoliosis surgery in Chinese adolescents[J]. Scoliosis, 2015(10): 28.
3.	Kumar A. Perioperative management of anemia: limits of blood transfusion and alternatives to it[J]. Cleve Clin J Med, 2009, 76(Suppl 4): S112-S118.
4.	Hardy JF, Desroches J. Natural and synthetic antifibrinolytics in cardiac surgery[J]. Can J Anaesth, 1992, 39(4): 353-365.
5.	Lin R, Baker A, Rose K, et al. Bleeding and coagulopathy associated with major spinal surgery[J]. Can J Anaesth, 1996, 43(Suppl 1): A46-B.
6.	Lecker I, Wang DS, Romaschin AD, et al. Tranexamic acid concentrations associated with human seizures inhibit glycine receptors[J]. J Clin Invest, 2012, 122(12): 4654-4666.
7.	Hiippala ST, Strid LJ, Wennerstrand MI, et al. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty[J]. Anesth Analg, 1997, 84(4): 839-844.
8.	Aguilera X, Videla S, Almenara M, et al. Effectiveness of tranexamic acid in revision total knee arthroplasty[J]. Acta Orthop Belg, 2012, 78(1): 68-74.
9.	Tan J, Chen H, Liu Q, et al. A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty[J]. J Surg Res, 2013, 184(2): 880-887.
10.	Fu DJ, Chen C, Guo L, et al. Use of intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials[J]. Chin J Traumatol, 2013, 16(2): 67-76.
11.	Zhou XD, Tao LJ, Li J, et al. Do we really need tranexamic acid in total hip arthroplasty? A meta-analysis of nineteen randomized controlled trials[J]. Arch Orthop Trauma Surg, 2013, 133(7): 1017-1027.
12.	Halanski MA, Cassidy JA, Hetzel S, et al. The efficacy of amicar versus tranexamic acid in pediatric spinal deformity surgery: a prospective, randomized, Double-Blinded pilot study[J]. Spine Deform, 2014, 2(3): 191-197.
13.	Verma K, Errico T, Diefenbach C, et al. The relative efficacy of antifibrinolytics in adolescent idiopathic scoliosis: a prospective randomized trial[J]. J Bone Joint Surg Am, 2014, 96(10): e80.
14.	Dhawale AA, Shah SA, Sponseller PD, et al. Are antifibrinolytics helpful in decreasing blood loss and transfusions during spinal fusion surgery in children with cerebral palsy scoliosis?[J]. Spine (Phila Pa 1976), 2012, 37(9): E549-E555.
15.	Yagi M, Hasegawa J, Nagoshi N, et al. Does the intraoperative tranexamic acid decrease operative blood loss during posterior spinal fusion for treatment of adolescent idiopathic scoliosis?[J]. Spine (Phila Pa 1976), 2012, 37(21): E1336-E1342.
16.	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.
17.	Xu CS, Wu AS, Yue Y. Which is more effective in adolescent idiopathic scoliosis surgery: batroxobin, tranexamic acid or a combination?[J]. Arch Orthop Trauma Surg, 2012, 132(1): 25-31.
18.	Newton PO, Bastrom TP, Emans JB, et al. Antifibrinolytic agents reduce blood loss during pediatric vertebral column resection procedures[J]. Spine (Phila Pa 1976), 2012, 37(23): E1459-E1463.
19.	Khurana A, Guha A, Saxena N, et al. Comparison of aprotinin and tranexamic acid in adult scoliosis correction surgery[J]. Eur Spine J, 2012, 21(6): 1121-1126.
20.	Garg B, Dhatt S, Chakraborty S. Use of single-dose tranexamic acid to reduce blood loss in operative thoracolumbar trauma: a comparative study[J]. Spine J, 2012, 12(9, Supple): S93.
21.	Raksakietisak M, Sathitkarnmanee B, Srisaen P, et al. Two doses of tranexamic acid reduce blood transfusion in complex spine surgery a prospective randomized study[J]. Spine (Phila Pa 1976), 2015, 40(24): E1257-E1263.
22.	Peters A, Verma K, Slobodyanyuk K, et al. Antifibrinolytics reduce blood loss in adult spinal deformity surgery: a prospective, randomized controlled trial[J]. Spine (Phila Pa 1976), 2015, 40(8): E443-E449.
23.	Endres S, Heinz M, Wilke A. Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for degenerative spinal stenosis with instability: a retrospective case control study[J]. BMC Surg, 2011(11): 29.
24.	Wang Q, Liu J, Fan R, et al. Tranexamic acid reduces postoperative blood loss of degenerative lumbar instability with stenosis in posterior approach lumbar surgery: a randomized controlled trial[J]. Eur Spine J, 2013, 22(9): 2035-2038.
25.	Fleege C, Almajali A, Rauschmann M, et al. Improve of surgical outcomes in spinal fusion surgery. Evidence based peri- and intra-operative aspects to reduce complications and earlier recovery[J]. Orthopade, 2014, 43(12): 1070-1078.
26.	Wong J, El Beheiry H, Rampersaud YR, et al. Tranexamic acid reduces perioperative blood loss in adult patients having spinal fusion surgery[J]. Anesth Analg, 2008, 107(5): 1479-1486.
27.	Elwatidy S, Jamjoom Z, Elgamal E, et al. Efficacy and safety of prophylactic large dose of tranexamic acid in spine surgery: a prospective, randomized, double-blind, placebo-controlled study[J]. Spine (Phila Pa 1976), 2008, 33(24): 2577-2580.
28.	Tsutsumimoto T, Shimogata M, Ohta H, et al. Tranexamic acid reduces perioperative blood loss in cervical laminoplasty: a prospective randomized study[J]. Spine (Phila Pa 1976), 2011, 36(23): 1913-1918.
29.	Bednar DA, Bednar VA, Chaudhary A, et al. Tranexamic acid for hemostasis in the surgical treatment of metastatic tumors of the spine[J]. Spine (Phila Pa 1976), 2006, 31(8): 954-957.
30.	Baldus CR, Bridwell KH, Lenke LG, et al. Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls[J]. Spine (Phila Pa 1976), 2010, 35(2): 235-239.
31.	Yang B, Li H, Wang D, et al. Systematic review and meta-analysis of perioperative intravenous tranexamic acid use in spinal surgery[J]. PLoS One, 2013, 8(2): e55436.
32.	Li ZJ, Fu X, Xing D, et al. Is tranexamic acid effective and safe in spinal surgery? A meta-analysis of randomized controlled trials[J]. Eur Spine J, 2013, 22(9): 1950-1957.
33.	Cheriyan T, Maier SP, Bianco K, et al. Efficacy of tranexamic acid on surgical bleeding in spine surgery: a meta-analysis[J]. Spine J, 2015, 15(4): 752-761.
34.	Jennings JD, Solarz MK, Haydel C. Application of tranexamic acid in trauma and orthopedic surgery[J]. Orthop Clin North Am, 2016, 47(1): 137.
35.	Farrokhi MR, Kazemi AP, Eftekharian HR, et al. Efficacy of prophylactic low dose of tranexamic acid in spinal fixation surgery: a randomized clinical trial[J]. J Neurosurg Anesthesiol, 2011, 23(4): 290-296.
36.	Sethna NF, Zurakowski D, Brustowicz RM, et al. Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery[J]. Anesthesiology, 2005, 102(4): 727-732.
37.	Xie JM, Lenke LG, Li T, et al. Preliminary investigation of high-dose tranexamic acid for controlling intraoperative blood loss in patients undergoing spine correction surgery[J]. Spine J, 2015, 15(4): 647-654.
38.	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.
39.	Verma K, Kohan E, Ames CP, et al.A comparison of two different dosing protocols for tranexamic acid in posterior spinal fusion for spinal deformity: a prospective, randomized trial[J].Int J Spine Surg, 2015(9): 65.
40.	Roberts I, Shakur H, Coats T, et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients[J]. Health Technol Assess (Rockv), 2013, 17(10): 1.
41.	CRASH-2 trial collaborators, Shakur H, Roberts I, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial[J]. Lancet, 2010, 376(9734): 23-32.
42.	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.
43.	Goodnough LT, Shander A, Brecher ME. Transfusion medicine: looking to the future[J]. Lancet, 2003, 361(9352): 161-169.
44.	Cravens GT, Brown MJ, Brown DR, et al. Antifibrinolytic therapy use to mitigate blood loss during staged complex major spine surgery: postoperative visual color changes after tranexamic acid administration[J]. Anesthesiology, 2006, 105(6): 1274-1276.
45.	Warner MA, Arens JF, Connis RT, et al. Practice advisory for perioperative visual loss associated with spine surgery an updated report by the American Society of Anesthesiologists task force on perioperative visual loss[J]. Anesthesiology, 2012, 116(2): 274-285.
46.	Schoenecker J, Mignemi N, Stutz CA, et al. 2010 young investigator award winner: therapeutic aprotinin stimulates osteoblast proliferation but inhibits differentiation and bone matrix mineralization[J]. Spine (Phila Pa 1976), 2010, 35(9): 1008-1016.
47.	Kara FM, Verma K, Xavier S, et al. Epsilon aminocaproic and transexamic acid decrease osteoblast differentiation and mineralization in vitro: E‐Poster 53[J]. Spine, 2009, 10(Suppl 3): 191.
48.	Cuellar JM, Yoo A, Tovar N, et al. The effects of amicar and TXA on lumbar spine fusion in an animal model[J]. Spine (Phila Pa 1976), 2014, 39(19): E1132-E1137.
49.	Danninger T, Memtsoudis SG. Tranexamic acid and orthopedic surgery-the search for the Holy Grail of blood conservation[J]. Ann Transl Med, 2015, 3(6): 77.

1. Lin ZX, Woolf SK. Safety, efficacy, and cost-effectiveness of tranexamic acid in orthopedic surgery[J]. Orthopedics, 2016, 39(2): 119-130.
2. Ng BK, Chau WW, Hung AL, et al. Use of tranexamic acid (TXA) on reducing blood loss during scoliosis surgery in Chinese adolescents[J]. Scoliosis, 2015(10): 28.
3. Kumar A. Perioperative management of anemia: limits of blood transfusion and alternatives to it[J]. Cleve Clin J Med, 2009, 76(Suppl 4): S112-S118.
4. Hardy JF, Desroches J. Natural and synthetic antifibrinolytics in cardiac surgery[J]. Can J Anaesth, 1992, 39(4): 353-365.
5. Lin R, Baker A, Rose K, et al. Bleeding and coagulopathy associated with major spinal surgery[J]. Can J Anaesth, 1996, 43(Suppl 1): A46-B.
6. Lecker I, Wang DS, Romaschin AD, et al. Tranexamic acid concentrations associated with human seizures inhibit glycine receptors[J]. J Clin Invest, 2012, 122(12): 4654-4666.
7. Hiippala ST, Strid LJ, Wennerstrand MI, et al. Tranexamic acid radically decreases blood loss and transfusions associated with total knee arthroplasty[J]. Anesth Analg, 1997, 84(4): 839-844.
8. Aguilera X, Videla S, Almenara M, et al. Effectiveness of tranexamic acid in revision total knee arthroplasty[J]. Acta Orthop Belg, 2012, 78(1): 68-74.
9. Tan J, Chen H, Liu Q, et al. A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty[J]. J Surg Res, 2013, 184(2): 880-887.
10. Fu DJ, Chen C, Guo L, et al. Use of intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials[J]. Chin J Traumatol, 2013, 16(2): 67-76.
11. Zhou XD, Tao LJ, Li J, et al. Do we really need tranexamic acid in total hip arthroplasty? A meta-analysis of nineteen randomized controlled trials[J]. Arch Orthop Trauma Surg, 2013, 133(7): 1017-1027.
12. Halanski MA, Cassidy JA, Hetzel S, et al. The efficacy of amicar versus tranexamic acid in pediatric spinal deformity surgery: a prospective, randomized, Double-Blinded pilot study[J]. Spine Deform, 2014, 2(3): 191-197.
13. Verma K, Errico T, Diefenbach C, et al. The relative efficacy of antifibrinolytics in adolescent idiopathic scoliosis: a prospective randomized trial[J]. J Bone Joint Surg Am, 2014, 96(10): e80.
14. Dhawale AA, Shah SA, Sponseller PD, et al. Are antifibrinolytics helpful in decreasing blood loss and transfusions during spinal fusion surgery in children with cerebral palsy scoliosis?[J]. Spine (Phila Pa 1976), 2012, 37(9): E549-E555.
15. Yagi M, Hasegawa J, Nagoshi N, et al. Does the intraoperative tranexamic acid decrease operative blood loss during posterior spinal fusion for treatment of adolescent idiopathic scoliosis?[J]. Spine (Phila Pa 1976), 2012, 37(21): E1336-E1342.
16. 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.
17. Xu CS, Wu AS, Yue Y. Which is more effective in adolescent idiopathic scoliosis surgery: batroxobin, tranexamic acid or a combination?[J]. Arch Orthop Trauma Surg, 2012, 132(1): 25-31.
18. Newton PO, Bastrom TP, Emans JB, et al. Antifibrinolytic agents reduce blood loss during pediatric vertebral column resection procedures[J]. Spine (Phila Pa 1976), 2012, 37(23): E1459-E1463.
19. Khurana A, Guha A, Saxena N, et al. Comparison of aprotinin and tranexamic acid in adult scoliosis correction surgery[J]. Eur Spine J, 2012, 21(6): 1121-1126.
20. Garg B, Dhatt S, Chakraborty S. Use of single-dose tranexamic acid to reduce blood loss in operative thoracolumbar trauma: a comparative study[J]. Spine J, 2012, 12(9, Supple): S93.
21. Raksakietisak M, Sathitkarnmanee B, Srisaen P, et al. Two doses of tranexamic acid reduce blood transfusion in complex spine surgery a prospective randomized study[J]. Spine (Phila Pa 1976), 2015, 40(24): E1257-E1263.
22. Peters A, Verma K, Slobodyanyuk K, et al. Antifibrinolytics reduce blood loss in adult spinal deformity surgery: a prospective, randomized controlled trial[J]. Spine (Phila Pa 1976), 2015, 40(8): E443-E449.
23. Endres S, Heinz M, Wilke A. Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for degenerative spinal stenosis with instability: a retrospective case control study[J]. BMC Surg, 2011(11): 29.
24. Wang Q, Liu J, Fan R, et al. Tranexamic acid reduces postoperative blood loss of degenerative lumbar instability with stenosis in posterior approach lumbar surgery: a randomized controlled trial[J]. Eur Spine J, 2013, 22(9): 2035-2038.
25. Fleege C, Almajali A, Rauschmann M, et al. Improve of surgical outcomes in spinal fusion surgery. Evidence based peri- and intra-operative aspects to reduce complications and earlier recovery[J]. Orthopade, 2014, 43(12): 1070-1078.
26. Wong J, El Beheiry H, Rampersaud YR, et al. Tranexamic acid reduces perioperative blood loss in adult patients having spinal fusion surgery[J]. Anesth Analg, 2008, 107(5): 1479-1486.
27. Elwatidy S, Jamjoom Z, Elgamal E, et al. Efficacy and safety of prophylactic large dose of tranexamic acid in spine surgery: a prospective, randomized, double-blind, placebo-controlled study[J]. Spine (Phila Pa 1976), 2008, 33(24): 2577-2580.
28. Tsutsumimoto T, Shimogata M, Ohta H, et al. Tranexamic acid reduces perioperative blood loss in cervical laminoplasty: a prospective randomized study[J]. Spine (Phila Pa 1976), 2011, 36(23): 1913-1918.
29. Bednar DA, Bednar VA, Chaudhary A, et al. Tranexamic acid for hemostasis in the surgical treatment of metastatic tumors of the spine[J]. Spine (Phila Pa 1976), 2006, 31(8): 954-957.
30. Baldus CR, Bridwell KH, Lenke LG, et al. Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls[J]. Spine (Phila Pa 1976), 2010, 35(2): 235-239.
31. Yang B, Li H, Wang D, et al. Systematic review and meta-analysis of perioperative intravenous tranexamic acid use in spinal surgery[J]. PLoS One, 2013, 8(2): e55436.
32. Li ZJ, Fu X, Xing D, et al. Is tranexamic acid effective and safe in spinal surgery? A meta-analysis of randomized controlled trials[J]. Eur Spine J, 2013, 22(9): 1950-1957.
33. Cheriyan T, Maier SP, Bianco K, et al. Efficacy of tranexamic acid on surgical bleeding in spine surgery: a meta-analysis[J]. Spine J, 2015, 15(4): 752-761.
34. Jennings JD, Solarz MK, Haydel C. Application of tranexamic acid in trauma and orthopedic surgery[J]. Orthop Clin North Am, 2016, 47(1): 137.
35. Farrokhi MR, Kazemi AP, Eftekharian HR, et al. Efficacy of prophylactic low dose of tranexamic acid in spinal fixation surgery: a randomized clinical trial[J]. J Neurosurg Anesthesiol, 2011, 23(4): 290-296.
36. Sethna NF, Zurakowski D, Brustowicz RM, et al. Tranexamic acid reduces intraoperative blood loss in pediatric patients undergoing scoliosis surgery[J]. Anesthesiology, 2005, 102(4): 727-732.
37. Xie JM, Lenke LG, Li T, et al. Preliminary investigation of high-dose tranexamic acid for controlling intraoperative blood loss in patients undergoing spine correction surgery[J]. Spine J, 2015, 15(4): 647-654.
38. 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.
39. Verma K, Kohan E, Ames CP, et al.A comparison of two different dosing protocols for tranexamic acid in posterior spinal fusion for spinal deformity: a prospective, randomized trial[J].Int J Spine Surg, 2015(9): 65.
40. Roberts I, Shakur H, Coats T, et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients[J]. Health Technol Assess (Rockv), 2013, 17(10): 1.
41. CRASH-2 trial collaborators, Shakur H, Roberts I, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial[J]. Lancet, 2010, 376(9734): 23-32.
42. 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.
43. Goodnough LT, Shander A, Brecher ME. Transfusion medicine: looking to the future[J]. Lancet, 2003, 361(9352): 161-169.
44. Cravens GT, Brown MJ, Brown DR, et al. Antifibrinolytic therapy use to mitigate blood loss during staged complex major spine surgery: postoperative visual color changes after tranexamic acid administration[J]. Anesthesiology, 2006, 105(6): 1274-1276.
45. Warner MA, Arens JF, Connis RT, et al. Practice advisory for perioperative visual loss associated with spine surgery an updated report by the American Society of Anesthesiologists task force on perioperative visual loss[J]. Anesthesiology, 2012, 116(2): 274-285.
46. Schoenecker J, Mignemi N, Stutz CA, et al. 2010 young investigator award winner: therapeutic aprotinin stimulates osteoblast proliferation but inhibits differentiation and bone matrix mineralization[J]. Spine (Phila Pa 1976), 2010, 35(9): 1008-1016.
47. Kara FM, Verma K, Xavier S, et al. Epsilon aminocaproic and transexamic acid decrease osteoblast differentiation and mineralization in vitro: E‐Poster 53[J]. Spine, 2009, 10(Suppl 3): 191.
48. Cuellar JM, Yoo A, Tovar N, et al. The effects of amicar and TXA on lumbar spine fusion in an animal model[J]. Spine (Phila Pa 1976), 2014, 39(19): E1132-E1137.
49. Danninger T, Memtsoudis SG. Tranexamic acid and orthopedic surgery-the search for the Holy Grail of blood conservation[J]. Ann Transl Med, 2015, 3(6): 77.

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氨甲环酸用于脊柱手术中的研究进展

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