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在对外科手术期间的松酸试验中的脏疾病
Cheng-Wei Liu1, Joshua Anih2, Victoria Lebedeva3
1Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.
Journal of clinical anesthesia
|February 22, 2024
概括
在外科手术期间进行的胺酸试验往往排除患有脏疾病的患者,从而限制了证据. 虽然它对轻度至中度功能障碍可能是安全的,但对严重病的影响仍然未知.
科学领域:
- 麻醉学和外科手术期间的医学.
- 科和脏疾病的疾病.
- 药理学和治疗学 药理学和治疗学
背景情况:
- 随机试验评估外科手术期间的松酸 (TXA) 历来排除了患有脏疾病的患者.
- 这种排除限制了对TXA在不同水平的功能中的安全性和有效性的理解.
研究的目的:
- 在随机试验中评估对外科手术期间的tranexamic acid进行脏疾病的处理.
- 评估特兰胺酸对不同功能水平的血栓事件,和出血的影响.
主要方法:
- 随机对照试验 (RCT) 的系统审查和元分析,更新至2023年7月.
- 对试验资格标准,剂量调整和根据功能分层的结果的分析.
- 对估计淋巴膜过率 (eGFR) <60和≥60毫升/分钟/1.73m2.2的患者发生的血栓事件的元分析.
主要成果:
- 在300项评估试验中,86.6%的参与者参加了排除病患者的研究.
- 只有5项试验调整了剂量以适应功能.
- 特兰胺酸对EGFR<60或≥60mL/min/1.73m2的血栓事件没有显著增加或减少,但排除了严重的脏疾病.
- 在一项试验中,功能子组的出血减少类似,该试验不包括具有肌素清除率<30mL/分钟的患者.
结论:
- 在特兰胺酸试验中广泛排除患有病的患者是常见的,并且可能是不合理的.
- 标准的外科手术期间的松酸剂量对于肌素清除率>30毫升/分钟似乎是安全有效的.
- 在患有严重病的患者中,特兰胺酸的安全性和有效性仍未确定.
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