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创伤后的特兰克萨姆酸时间和死亡率影响
Adnan Ali1, Russell L Gruen2, Stephen A Bernard3
1Clinical Hub for Interventional Research, John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia.
Annals of emergency medicine
|August 2, 2025
概括
在受伤后90分钟内提前给药tranexamic acid (TXA) 可以显著降低创伤死亡率. 在此窗口之外,TXA在预防创伤患者28天死亡方面没有显著的益处.
科学领域:
- 创伤的复苏创伤的复苏
- 紧急医疗 紧急医疗
- 药理学 药理学是指药理学的学科.
背景情况:
- 根据CRASH-2试验数据,目前的创伤复苏指南建议在受伤后3小时内使用特兰胺酸 (TXA).
- 这个3小时的窗口没有被独立复制,这促使进一步调查最佳时机.
研究的目的:
- 为了确定创伤后28天死亡率是否随着第一个TXA剂量的时间而变化.
- 准确地定义TXA在重创患者中的治疗窗口.
主要方法:
- 对PATCH-Trauma试验的探索性分析,涉及患有重大创伤和可疑凝血病的成年人.
- 患者接受了TXA或安慰剂;使用连续函数分析了从受伤到第一个TXA剂量的时间.
- 基于治疗时间,使用日志双项回归来评估28天内死亡风险.
主要成果:
- 这项研究包括1287名患者;第一剂TXA的中位时间为79分钟.
- 随着TXA的延迟使用,死亡风险增加,受益最明显的是在受伤后90分钟.
- 在90分钟内服用TXA显著降低了28天死亡率 (aRR为0.64),而在90分钟后服用TXA则没有显著的益处 (aRR为1.04).
结论:
- 在创伤患者中使用TXA的最佳治疗窗口似乎是在受伤后90分钟内.
- 这一发现表明,TXA疗效的窗口比以前建立的窗口更窄,更为关键.
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