规范化氨甲环酸使用降低扁桃体切除术后活动性出血的手术干预率：一项回顾性队列研究
Protocolized tranexamic acid use lowers surgical intervention rates after active post-tonsillectomy hemorrhage: A retrospective cohort study.
文献信息
| PMID | 42893660 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Spencer H Short |
| 作者单位 | Lehigh Valley Health Network, Otolaryngology - Head and Neck Surgery, United States. Electronic address: Spencer.Short2@jefferson.edu. |
| 期刊 | International journal of pediatric otorhinolaryngology |
| SCI 分区 | Q2 |
| IF | 1.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 评估标准化氨甲环酸（TXA）方案是否与扁桃体切除术后活动性出血（PTH）患者手术干预减少相关。
方法： 这项回顾性队列研究纳入2021年1月1日至2025年7月31日期间在一家三级儿童耳鼻咽喉科服务机构接受评估、记录有活动性PTH的2至21岁患者。在5342例扁桃体切除术中，246例患者因疑似PTH返回，116例符合活动性出血或血凝块的纳入标准。TXA方案于2024年7月25日实施。主要结局为用于控制出血的手术干预。分析了TXA使用、方案实施时期、给药途径与手术干预之间的关联。
结果： 在116例纳入患者中，手术干预从方案实施前的63%降至实施后的40%（OR 2.50；95% CI 1.18-5.25；p = .02）。总体而言，未接受TXA的30例患者中有27例（90%）需要手术干预，而接受TXA的86例患者中有33例（38%）需要手术干预（OR 0.07；95% CI 0.02-0.25；p < .001）。在调整分析中，TXA给药途径与手术干预显著相关（p < .001）。与未使用TXA相比，雾化、静脉以及雾化/静脉联合TXA均与手术干预的调整后比值降低相关；分层分析提示雾化TXA是最一致的驱动因素。
结论： 规范化TXA使用与儿童和年轻成人活动性PTH患者手术干预减少相关，其中雾化TXA与避免返回手术室的相关性最强。该研究受限于其回顾性设计以及使用单家三级中心的数据。
英文摘要
OBJECTIVE: To evaluate whether a standardized tranexamic acid (TXA) protocol was associated with reduced operative intervention among patients with active post-tonsillectomy hemorrhage (PTH).
METHODS: This retrospective cohort study included patients aged 2 to 21 years with documented active PTH evaluated at a tertiary pediatric otolaryngology service from January 1, 2021, to July 31, 2025. Of 5342 tonsillectomies, 246 patients returned with suspected PTH and 116 met inclusion criteria for active bleeding or clot. A TXA protocol was implemented July 25, 2024. The primary outcome was operative intervention for hemorrhage control. Associations between TXA use, protocol era, route, and operative intervention were analyzed.
RESULTS: Among 116 included patients, operative intervention decreased from 63% before protocol implementation to 40% after implementation (OR 2.50; 95% CI 1.18-5.25; p = .02). Overall, 27 of 30 patients (90%) who did not receive TXA required operative intervention, compared with 33 of 86 patients (38%) who received TXA (OR 0.07; 95% CI 0.02-0.25; p < .001). In adjusted analysis, TXA route was significantly associated with operative intervention (p < .001). Compared with no TXA, nebulized, intravenous, and combined nebulized/intravenous TXA were each associated with lower adjusted odds of operative intervention; stratified analyses suggested nebulized TXA was the most consistent driver.
CONCLUSION: Protocolized TXA use was associated with reduced operative intervention in children and young adults with active PTH, with nebulized TXA showing the strongest association with avoidance of return to the operating room. The study was limited by its retrospective design and utilization of data from a single tertiary center.