The role of Amicar in decreasing perioperative blood loss in idiopathic scoliosis
The role of Amicar in decreasing perioperative blood loss in idiopathic scoliosis
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DOI：
10.1097/01.brs.0000175188.05542.a9
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发表时间：
2005-09-01
期刊：
影响因子：
3
通讯作者：
Poe-Kochert, C
中科院分区：
文献类型：
--
作者：
Thompson, GH;Florentino-Pineda, I;Poe-Kochert, C
研究设计.四项关于Amicar在减少特发性脊柱侧凸围手术期失血量方面作用的独立研究。评估Amicar的疗效和可能的作用机制。初步的前瞻性、随机双盲和同日前路脊柱融合（ASF）、纤维蛋白原和后路脊柱融合（PSF）研究的分析表明，Amicar在特发性脊柱侧凸手术中有效。纤维蛋白原分泌增加是一种可能的解释。Amicar以100 mg/kg在15分钟内给药，麻醉诱导时不超过5 g。维持为每小时10 mg/kg，直至伤口闭合。初步研究：与对照组（N = 31）相比，Amicar（N = 28）有效。Amicar组PSF后的围手术期失血量和输血量分别为1，604 +/- 517 mL和1.1 +/- 1.0 U，而对照组分别为2，312 +/- 994 mL和2.1 +/- 1.1 U（P < 0.003）。前瞻性随机双盲研究证实了这种疗效，尽管主要是在术后吸引引流中：1，391 212 mL和1.1 +/- 1.0 U与1，716 +/- 513 mL和2.1 +/- 1.3 U相比（P < 0.002）。一项纤维蛋白原研究（N = 21）显示PSF后稳定且过度升高：术前为266 +/- 63 mg/dL，术后第5天为699 +/- 94 mg/dL。在同一天的前路和后路脊柱手术中，Amicar再次有效，但主要是在减少胸管引流和PSF期间。第1组（N = 15，无Amicar 3，807 105 mL和3.1 +/- 1.5 U）;第2组（N = 27，Amicar仅用于PSF）2，080 659 mL和1.9 +/- 0.9 U;第3组（N = 16，ASF和PSF）2，183 851 mL和1.0 +/- 0.8 U。Amicar在减少围手术期失血方面非常有效。这导致更少的自体献血，输血，成本和并发症。其作用机制尚不确定，但可能与纤维蛋白原分泌增加有关。
Study Design. Four separate studies on the role of Amicar in decreasing perioperative blood loss in idiopathic scoliosis.Objectives. To assess the efficacy and possible mechanisms of action for Amicar.Summary of Background Data. Preliminary prospective, randomized double-blind and analysis of same-day anterior spinal fusion (ASF), fibrinogen, and posterior spinal fusion (PSF) studies have demonstrated Amicar to be effective in idiopathic scoliosis surgery. Increased fibrinogen secretion is a possible explanation.Methods. Amicar is administered at 100 mg/kg over 15 minutes not to exceed 5 g at anesthesia induction. Maintenance is 10 mg/kg per hour until wound closure.Results. Preliminary study: Amicar (N = 28) was effective compared with a control group (N = 31). Perioperative blood loss and transfusion following PSF were 1,604 +/- 517 mL and 1.1 +/- 1.0 U in the Amicar group compared with 2,312 +/- 994 mL and 2.1 +/- 1.1 U in the control group (P < 0.003). Prospective, randomized double-blind study confirmed this efficacy, although primarily in postoperative suction drainage: 1,391 212 mL and 1.1 +/- 1.0 U compared with 1,716 +/- 513 mL and 2.1 +/- 1.3 U (P < 0.002). A fibrinogen study (N = 21) demonstrated steady and excessive increase following PSF: before surgery it was 266 +/- 63 mg/dL and on the fifth postoperative day 699 +/- 94 mg/dL. In same-day anterior and posterior spinal surgery, Amicar was again effective, but primarily in decreasing chest tube drainage and during PSF. Group 1 (N = 15, no Amicar 3,807 105 mL and 3.1 +/- 1.5 U; Group 2 (N = 27, Amicar for PSF only) 2,080 659 mL and 1.9 +/- 0.9 U; and Group 3 (N = 16, both ASF and PSF) 2,183 851 mL and 1.0 +/- 0.8 U.Conclusions. Amicar appears highly effective in decreasing perioperative blood loss. This results in less autologous blood donation, blood transfusion, costs, and complications. Its mechanism of action is uncertain but may be related to increased fibrinogen secretion.