思春期脊柱側弯症の矯正手術におけるトラネキサム酸投与の有用性の検討
はじめに：思春期脊柱側弯症の矯正手術におけるトラネキサム酸（TXA）投与の有用性について後ろ向きに検討した．対象と方法：思春期脊柱側弯症にて後方矯正固定術を施行し術中にTXA投与を行った10例と，対照群として性別，年齢，カーブタイプ，術前Cobb角，手術時間をマッチングさせたTXA非投与の過去の手術症例10例を比較検討した．TXA投与を皮膚切開前に10 mg/kgを初期負荷静注し1 mg/kg/hrで皮膚縫合終了まで持続投与した．TXA投与群と非投与群の2群間で術中出血量，輸血量，合併症を検討した．結果：平均出血量はTXA投与群で平均563 g，非投与群で平均936 gとTXA投与群で少ない傾...
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| Published in | Journal of Spine Research Vol. 13; no. 12; pp. 1277 - 1281 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脊椎脊髄病学会
20.12.2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1884-7137 2435-1563 |
| DOI | 10.34371/jspineres.2022-1212 |
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| Abstract | はじめに：思春期脊柱側弯症の矯正手術におけるトラネキサム酸（TXA）投与の有用性について後ろ向きに検討した．対象と方法：思春期脊柱側弯症にて後方矯正固定術を施行し術中にTXA投与を行った10例と，対照群として性別，年齢，カーブタイプ，術前Cobb角，手術時間をマッチングさせたTXA非投与の過去の手術症例10例を比較検討した．TXA投与を皮膚切開前に10 mg/kgを初期負荷静注し1 mg/kg/hrで皮膚縫合終了まで持続投与した．TXA投与群と非投与群の2群間で術中出血量，輸血量，合併症を検討した．結果：平均出血量はTXA投与群で平均563 g，非投与群で平均936 gとTXA投与群で少ない傾向を認めた（P=0.089）．平均輸血量はTXA投与群で平均153 g，非投与群で平均847 gであった（P=0.003）．両群ともに合併症は認めなかった．今回の検討では輸血量の有意な減少を認めた．結語：術中出血量の有意な減少にはより高用量の投与が必要と考えられた．思春期側弯症の矯正手術においてTXA投与は術中出血対策に有効である可能性が示唆された． |
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| AbstractList | はじめに：思春期脊柱側弯症の矯正手術におけるトラネキサム酸（TXA）投与の有用性について後ろ向きに検討した．対象と方法：思春期脊柱側弯症にて後方矯正固定術を施行し術中にTXA投与を行った10例と，対照群として性別，年齢，カーブタイプ，術前Cobb角，手術時間をマッチングさせたTXA非投与の過去の手術症例10例を比較検討した．TXA投与を皮膚切開前に10 mg/kgを初期負荷静注し1 mg/kg/hrで皮膚縫合終了まで持続投与した．TXA投与群と非投与群の2群間で術中出血量，輸血量，合併症を検討した．結果：平均出血量はTXA投与群で平均563 g，非投与群で平均936 gとTXA投与群で少ない傾向を認めた（P=0.089）．平均輸血量はTXA投与群で平均153 g，非投与群で平均847 gであった（P=0.003）．両群ともに合併症は認めなかった．今回の検討では輸血量の有意な減少を認めた．結語：術中出血量の有意な減少にはより高用量の投与が必要と考えられた．思春期側弯症の矯正手術においてTXA投与は術中出血対策に有効である可能性が示唆された． |
| Author | 鈴木, 秀典 田口, 敏彦 永尾, 祐治 坂井, 孝司 富永, 俊克 西田, 周泰 寒竹, 司 今城, 靖明 舩場, 真裕 |
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| References | 8) Morrison JJ, Dubose JJ, Rasmussen TE, et al: Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg. 2012; 147: 113-119 7) Keyl C, Uhl R, Beyersdorf F, et al: High-dose tranexamic acid is related to increased risk of generalized seizures after aortic valve replacement. Eur J Cardiothorac Surg. 2011; 39: e114-e121 4) Cheriyan T, Maier SP, Bianco K, et al: Efficacy of tranexamic acid on surgical bleeding in spine surgery: a meta-analysis. Spine J. 2015; 15: 752-761 6) Alshryda S, Sarda P, Sukeik M, et al: Tranexamic acid in total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Br. 2011; 93: 1577-1585 11) Neilipovitz DT, Murto K, Hall L, et al: A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg. 2001; 93: 82-87 3) Yang B, Li H, Wang D, et al: Systematic review and meta-analysis of perioperative intravenous tranexamic acid use in spinal surgery. PLoS One. 2013; 8: e55436 10) Fiechtner BK, Nuttall GA, Johnson ME, et al: Plasma Tranexamic Acid Concentrations During Cardiopulmonary Bypass. Anesth Analg. 2001; 92: 1131-1136 1) McCormack PL: Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs. 2012; 72: 585-617 13) Goobie SM, Zurakowski D, Glotzbecker MP, et al: Tranexamic Acid Is Efficacious at Decreasing the Rate of Blood Loss in Adolescent Scoliosis Surgery: A Randomized Placebo-Controlled Trial. J Bone Joint Surg Am. 2018; 100: 2024-2032 12) Johnson DJ, Johnson CC, Goobie SM, et al: High-dose Versus Low-dose Tranexamic Acid to Reduce Transfusion Requirements in Pediatric Scoliosis Surgery. J Pediatr Orthop. 2017; 37: e552-e557 2) CRASH-2 collaborators; Shakur H, Roberts I, Bautista R, 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. Lancet. 2010; 376: 23-32 9) 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. Ann N Y Acad Sci. 1968; 146: 642-658 5) Sukeik M, Alshryda S, Haddad FS, et al: Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Joint Surg Br. 2011; 93: 39-46 |
| References_xml | – reference: 3) Yang B, Li H, Wang D, et al: Systematic review and meta-analysis of perioperative intravenous tranexamic acid use in spinal surgery. PLoS One. 2013; 8: e55436 – reference: 8) Morrison JJ, Dubose JJ, Rasmussen TE, et al: Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg. 2012; 147: 113-119 – reference: 10) Fiechtner BK, Nuttall GA, Johnson ME, et al: Plasma Tranexamic Acid Concentrations During Cardiopulmonary Bypass. Anesth Analg. 2001; 92: 1131-1136 – reference: 9) 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. Ann N Y Acad Sci. 1968; 146: 642-658 – reference: 6) Alshryda S, Sarda P, Sukeik M, et al: Tranexamic acid in total knee replacement: a systematic review and meta-analysis. J Bone Joint Surg Br. 2011; 93: 1577-1585 – reference: 12) Johnson DJ, Johnson CC, Goobie SM, et al: High-dose Versus Low-dose Tranexamic Acid to Reduce Transfusion Requirements in Pediatric Scoliosis Surgery. J Pediatr Orthop. 2017; 37: e552-e557 – reference: 11) Neilipovitz DT, Murto K, Hall L, et al: A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery. Anesth Analg. 2001; 93: 82-87 – reference: 13) Goobie SM, Zurakowski D, Glotzbecker MP, et al: Tranexamic Acid Is Efficacious at Decreasing the Rate of Blood Loss in Adolescent Scoliosis Surgery: A Randomized Placebo-Controlled Trial. J Bone Joint Surg Am. 2018; 100: 2024-2032 – reference: 4) Cheriyan T, Maier SP, Bianco K, et al: Efficacy of tranexamic acid on surgical bleeding in spine surgery: a meta-analysis. Spine J. 2015; 15: 752-761 – reference: 7) Keyl C, Uhl R, Beyersdorf F, et al: High-dose tranexamic acid is related to increased risk of generalized seizures after aortic valve replacement. Eur J Cardiothorac Surg. 2011; 39: e114-e121 – reference: 1) McCormack PL: Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis. Drugs. 2012; 72: 585-617 – reference: 5) Sukeik M, Alshryda S, Haddad FS, et al: Systematic review and meta-analysis of the use of tranexamic acid in total hip replacement. J Bone Joint Surg Br. 2011; 93: 39-46 – reference: 2) CRASH-2 collaborators; Shakur H, Roberts I, Bautista R, 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. Lancet. 2010; 376: 23-32 |
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| Title | 思春期脊柱側弯症の矯正手術におけるトラネキサム酸投与の有用性の検討 |
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