Effects of topical antifibrinolytics in endoscopic sinus surgery: A pilot randomized controlled trial
Effects of topical antifibrinolytics in endoscopic sinus surgery: A pilot randomized controlled trial
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DOI：
10.2500/ajr.2007.21.3097
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发表时间：
2007-11-01
期刊：
影响因子：
--
通讯作者：
Wormald, Peter J.
中科院分区：
文献类型：
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作者：
Athanasiadis, Theodore;Beule, Achim G.;Wormald, Peter J.
背景资料：内窥镜鼻窦手术（ESS）中的出血可能会增加术中并发症的风险，并与不良结局相关。抗纤溶药物已被证明可以减少出血，如果全身给药。本研究的目的是确定局部ε-氨基己酸（EACA）和氨甲环酸（TA）在手术领域出血在ESS.Methods的影响：一个前瞻性的盲随机对照试验进行。30例接受ESS的患者随机接受2.5 g EACA、100 mg TA或1 g TA，而对侧接受生理盐水。在每侧操作结束时，将溶液以喷雾形式施用。出血记录使用标准化的视频内窥镜和分级scales.Results：EACA没有显示出显着的影响，术中出血。100 mg TA在应用后2、4和6分钟显示出手术区域的临床显著改善。2分钟的平均值为TA，1.6 +/- 1.08，对照组，2.2 +/- 1.3; 4分钟时为TA，1.25 +/- 1.2，对照组，1.7 +/- 1.2; 6分钟时为TA，0.75 +/- 1.2，对照组，1.3 +/- 1.4（p < 0.05）。Ig的TA在所有时间点也接近显著性。两个TA组的综合结果显示，在应用后2、4、6和8分钟，术野显著改善。在80%的病例中，设盲外科医生认为TA比生理盐水更有效。结论：局部应用TA可有效止血，改善手术视野。与EACA相比，TA是ESS中值得额外评估的有价值的工具。
Background: Bleeding in endoscopic sinus surgery (ESS) may increase the risk of intraoperative complications and is associated with poorer outcomes Antifibrinolytic agents have been shown to reduce bleeding if administered systemically. The aim of this study was to determine the effect of topical epsilon-aminocaproic acid (EACA) and tranexamic acid (TA) on bleeding in the surgical field during ESS.Methods: A prospective blind randomized controlled trial was performed. Thirty patients undergoing ESS were randomized to receive either 2.5 g of EACA, 100 mg of TA, or I g of TA while the contralateral side received saline. The solution was applied as a spray at the conclusion of operating on each side. Bleeding was documented using standardized videoendoscopy and grading scales.Results: EACA did not show a significant effect on intraoperative bleeding. TA at 100 mg showed a clinically significant improvement in the surgical field at 2, 4, and 6 minutes after application. The mean for 2 minutes was TA, 1.6 +/- 1.08, and control, 2.2 +/- 1.3; at 4 minutes was TA, 1.25 +/- 1.2, and control, 1.7 +/- 1.2,; and at 6 minutes was TA, 0.75 +/- 1.2, and control, 1.3 +/- 1.4 (p < 0.05). TA at I g also approached significance at all time points. Combined results from the two TA groups showed a significant improvement in the surgical field at 2, 4, 6, and 8 minutes after application. TA was regarded by the blinded surgeon as more effective than saline in 80% of cases. No adverse effects were encountered after topical application of either drug.Conclusion: Topical application of TA is effective in achieving hemostasis and improving the surgical field. In contrast to EACA, TA is a valuable tool in ESS that merits additional evaluation.