在下关节出血 (ULTRA) 后的超早期胺酸:随机对照试验
René Post1, Menno R Germans2, Maud A Tjerkstra1
1Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Lancet (London, England)
|December 28, 2020
概括
超早期对神经瘤下关节出血的治疗没有改善6个月的临床结果. 虽然它降低了复出血的风险,但整体修改的兰金尺度得分在接受这种抗纤维解药治疗的患者中没有显著的益处.
科学领域:
- 神经学
- 神经外科
- 危急护理医学
背景情况:
- 动脉瘤下关节出血 (aSAH) 携带高风险的再次出血.
- 已知短期使用的松酸 (TXA) 可减少复出血,但其对长期临床结果的影响尚不确定.
研究的目的:
- 为了研究超早期的,短期的松酸在6个月后改善aSAH患者的临床结果的有效性.
- 评估TXA对复出率和其他严重不良事件的影响.
主要方法:
- 一个多中心的,前性的,随机的,受控的,开放的标签试验与盲目的结果评估.
- 成年患者在CT检测中发现了自发的下关节出血,被随机分组为接受特兰克萨姆酸加常规治疗或仅接受常规治疗.
- 在诊断后立即给予TXA (1g玻尿酸,然后每8小时输注1g) 直到动脉瘤治疗或24小时.
主要成果:
- 共有955名患者被录取;其中480名患者接受了松酸治疗,475名患者接受了标准治疗.
- 在TXA组的60%,对照组的64% (OR 0.86;95%CI 0.66-1.12) 观察到6个月后的良好临床结果.
- 在动脉瘤治疗之前,TXA组的10%发生了复出出血,对照组的14%发生了复出血 (OR 0. 71;95% CI 0. 48- 1. 04).
结论:
- 超早期,短期的松酸治疗没有显著改善6个月的临床结果在患有瘤下关节出血的患者.
- 虽然tranexamic acid显示出降低再出血的趋势,但它并没有转化为更好的功能恢复,根据修改的兰金尺度进行测量.
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