Objective: To evaluate the perioperative tranexamic acid (TXA) on blood conservation in pediatric patients undergoing complete repair for tetralogy of fallot (TOF) and its impact on short-term or long-term adverse event and mortality. Methods: The study was a retrospective cohort study. From January 2009 to December 2010, 386 consecutive patients aged from 31 days to 8 years old, ASA physical status Ⅱ or Ⅲ, receiving primary complete repair for TOF in Fuwai Hospital were enrolled in the study. They were divided into two groups: the control group (n=161) and the TXA group (n=225), according to whether TXA was used during the operation. Patients and their families were followed up by telephone in the 8th-year after surgery. The amount of perioperative blood loss, allogeneic transfusion, short-term or long-term adverse event and mortality were recorded and analyzed. Results: The patients in the TXA group were associated with significant decreased 12 h and total postoperative blood loss compared with the control group [(7.8±0.3) ml/kg vs (8.8±0.3) ml/kg, t=2.412, P<0.05; and (14.0±0.6) ml/kg vs (17.0±0.7) ml/kg, t=3.141, P<0.05]. There were no significant differences in both the volume and incidence of red blood cell, plasma, and platelet transfusion, postoperatively (P>0.05). There were no significant differences in the incidence of reoperation for bleeding and prolonged mechanical ventilation, ICU stay, postoperative hospital length of stay, the short-term and long-term incidence of seizure, stroke, renal failure, deep venous thrombosis, pulmonary embolism and death between the two groups(P>0.05). Conclusion: TXA can decrease postoperative blood loss, but has little impact on the allogeneic blood transfusion, as well as the short-term or long-term adverse event and mortality in pediatric patients undergoing complete repair for TOF.
目的： 评价氨甲环酸（TXA）对接受法洛四联症（TOF）矫治术患儿围术期的血液保护作用及对近、远期不良事件发生率和病死率的影响。 方法： 回顾性队列研究。连续选取本院2009年1月—2010年12月首次接受TOF矫治术的386例患儿，根据术中是否应用TXA被分为TXA组（n=225）和对照组（n=161），年龄31 d~8岁，美国麻醉医师协会分级为Ⅱ或Ⅲ级；麻醉医师在术后第8年对患儿家属进行电话随访。记录并统计分析患儿主要的围术期出血和输血情况，以及术后近、远期不良事件的发生率和病死率。 结果： TXA组术后12 h出血量为（7.8±0.3）ml/kg，术后总出血量为（14.0±0.6）ml/kg，少于对照组的（8.8±0.3）ml/kg和（17.0±0.7）ml/kg，差异均有统计学意义（t=2.412、3.141，均P<0.05）。两组患者间红细胞、血浆和血小板输注量及输注率的差异均无统计学意义（均P>0.05）。两组患者间二次开胸止血率、术后长时间机械通气发生率、ICU停留时间、术后住院时间以及癫痫、卒中、肾功能衰竭、下肢深静脉血栓、肺动脉血栓发生率和病死率的差异均无统计学意义（均P>0.05）。 结论： TXA可有效降低接受TOF矫治术患儿的术后出血，对术后异体血制品的输注没有影响，对术后近、远期不良事件的发生率和病死率亦无影响。.
Keywords: Blood transfusion; Intraoperative complications; Prognosis; Tetralogy of Fallot; Tranexamic acid.