摘要
目的 评估早期静脉注射氨甲环酸对创伤性颅脑损伤合并颅内出血患者的疗效。方法 前瞻性研究2021年8月-2022年5月华中科技大学同济医学院附属同济医院创伤外科收治创伤性颅脑损伤合并颅内出血患者74例,男性患者51例,占比68.9%。将纳入患者按随机数字表法1∶1分为实验组及对照组,实验组损伤后3h内予以1g氨甲环酸10min内缓慢静推,然后予以1g氨甲环酸持续输注8h;对照组以安慰剂(0.9%生理盐水)按实验组同样方式处理。通过入院时和伤后48h的头颅CT平扫比较两组患者颅内血肿的改变,同时比较两组患者病死率、血管闭塞事件及后遗症发生率等临床指标,综合评估患者临床结局。结果 两组患者一般资料中年龄、性别、致伤机制、GCS及GCS人群分布情况等指标未见明显组间差异(P均>0.05)。实验组平均住院天数较对照组少[(16.8±13.3)dvs.(23.0±17.7)d,P<0.05]。实验组接受手术治疗的比例较对照组低(8.1%vs. 27.0%,P<0.05)。入院48h后头部CT示实验组颅内血肿体积较入院时明显减少,而对照组入院48h后颅内血肿体积较前稍增多,两组间比较差异有统计学意义[5.1(2.2,28)vs. 9.8(2.8,48.3),P<0.05]。两组患者院内病死率、血管栓塞事件等并发症及伤后3个月后遗症发生率等指标比较差异无统计学意义(P>0.05)。结论 静脉注射氨甲环酸治疗对颅脑损伤患者安全有效,规范化的早期用药可以有效减少血肿体积、降低手术治疗率、缩短住院时间等,同时不会增加患者后遗症及血栓闭塞事件等并发症发生率。
Objective To evaluate the efficacy of early intravenous injection of tranexamic acid in patients with traumatic brain injuries(TBIs)complicated with intracranial hemorrhage.Methods From Aug.2021 to May 2022,74 TBI patients complicated with intracranial hemorrhage treated in the Department of Traumatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology were prospectively enrolled.The mean age was(41.13±13.35)years and there were 51 male patients(68.9%).The included patients were randomly divided into experimental group and control group at a 1∶1 ratio by random number table.Among them,the experimental group was given 1 g tranexamic acid via intravenous injection in 10 min within the time period of 3 h after injury and 1 g tranexamic acid via continuous intravenous infusion for 8 h;while the control group received placebo treatment(0.9%normal saline)in the same way.The changes in the intracranial hematoma volume were recorded on admission and 48 h after treatment by CT and compared between two groups.At the same time,the mortality,incidence of complications and sequelae,and comprehensive outcomes were evaluated and compared between two groups.Results There was no significant difference in age,gender,injury mechanism,GCS score or distribution of injury severities between the two groups(all P>0.05).Compared with the control group,the experimental group had significantly shorter average hospitalization days(16.8±13.3 vs.23.0±17.7)and a much lower proportion of patients that received surgical treatment(8.1%vs.27.0%,both P<0.05).CT scan at 48 h after admission showed that the volume of the intracranial hematoma was significantly decreased in the experimental group but slightly increased in the control group,and the difference was significant between the two groups[mL,5.1(2.2,28.0)vs.9.8(2.8,48.3),P<0.05].There was no significant difference in hospital mortality,vascular embolism and other complications,or the incidence of sequelae in 3 months after injury between the two gr
作者
武芬
武齐齐
苏伟
李占飞
杨帆
Wu Fen;Wu Qiqi;Su Wei;Li Zhanfei;Yang Fan(Department of Pharmacy,the Red Cross Hospital of Wuhan,Wuhan 430015,China;Department of Traumatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《创伤外科杂志》
2023年第10期767-772,共6页
Journal of Traumatic Surgery
关键词
创伤性颅脑损伤
颅内血肿
预后
随机对照试验
Brain injuries,traumatic
Intracranial hematoma
Outcome
Randomized controlled trial
