William Ian McKinley, Christos Lazaridis, Ali Mansour, Lea Hoefer, Ann Polcari, Andrew Benjamin, Martin Schreiber, Susan E Rowell
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引用次数: 0
Abstract
Background: Traumatic brain injury (TBI) contributes to substantial morbidity and mortality worldwide. Tranexamic acid (TXA) has been shown to reduce mortality in patients with traumatic intracranial hemorrhage (ICH) when given within 2 hours of injury. Although TXA is an antifibrinolytic, most studies have observed no difference in ICH progression; recent studies suggest that TXA may reduce cerebral edema in TBI. Our objective was to determine if prehospital TXA administered within 2 hours of injury is associated with surrogates of cerebral edema in patients with moderate or severe TBI.
Methods: We performed a retrospective analysis of a multinational prehospital trial of TXA administered within 2 hours of injury in patients with moderate or severe TBI. Patients with prehospital Glasgow Coma Scale score of <13 and systolic blood pressure of >90 mm Hg were randomized to placebo, 2-g TXA bolus, or 1-g TXA bolus followed by 1 g 8-hour TXA infusion. Patients who received an intracranial pressure (ICP) monitor were selected for analysis. Baseline demographic, injury severity, and infusion characteristics were compared between TXA dosing cohorts. Proportion of hours spent with ICP of >20 mm Hg, cerebral perfusion pressure (CPP) of <60 mm Hg, and need for craniectomy were compared between groups.
Results: A total of 108 patients with ICP monitors made up the study population (placebo, n = 31; 1 g + 1 g, n = 38; 2-g bolus, n = 39). No differences were identified in age, sex, Abbreviated Injury Scale head, Glasgow Coma Scale, Injury Severity Score, crystalloid and blood product infused in first 24 hours, Marshall score, ICH, or mortality between the three treatment arms. No differences in proportions of hours in which ICP of >20 mm Hg or CPP of <60 mm Hg were identified between treatment arms; rate of craniectomy was also similar.
Conclusion: No association could be identified between TXA treatment and ICP elevation, CPP depression, or need for craniectomy. These results question TXA's potential impact on cerebral edema. Further study is needed to confirm this finding based on the exploratory nature and limited number of subjects in this study.
Level of evidence: Therapeutic/Care Management; Level IV.
背景：外伤性脑损伤（TBI）是世界范围内发病率和死亡率较高的疾病之一。经证实，创伤性颅内出血（ICH）患者在受伤后2小时内给予氨甲环酸（TXA）可降低死亡率。虽然TXA是一种抗纤溶剂，但大多数研究没有观察到脑出血进展的差异；最近的研究表明，TXA可以减轻脑外伤患者的脑水肿。我们的目的是确定在受伤后2小时内给予院前TXA是否与中度或重度TBI患者脑水肿的替代物相关。方法：我们对一项跨国院前试验进行了回顾性分析，该试验在中度或重度TBI患者受伤后2小时内给予TXA。院前格拉斯哥昏迷量表评分为90 mm Hg的患者随机分为安慰剂组、2 g TXA丸组或1 g TXA丸组，然后输注1 g 8小时TXA。选择接受颅内压（ICP）监测的患者进行分析。比较TXA给药队列之间的基线人口统计学、损伤严重程度和输注特征。颅内压(ICP)≥20 mm Hg的时间比例，脑灌注压（CPP）结果：共有108例患者使用ICP监测仪组成研究人群(安慰剂，n = 31；1g + 1g, n = 38；2 g, n = 39)。在三个治疗组之间，年龄、性别、简易损伤量表头部、格拉斯哥昏迷量表、损伤严重程度评分、前24小时内输注的晶体和血液制品、马歇尔评分、ICH或死亡率均无差异。结论：TXA治疗与ICP升高、CPP降低或需要开颅手术之间没有相关性。这些结果质疑TXA对脑水肿的潜在影响。基于本研究的探索性和受试者数量有限，需要进一步的研究来证实这一发现。证据水平：治疗/护理管理；IV级。
期刊介绍：
The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.
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