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【論文摘要】斷血炎在外傷性到院前心肺功能停止的效益
【論文摘要】Effect of Prehospital Transamine of Traumatic Out-of-Hospital Cardiac Arrest
摘要
研究方法（或案例描述）：大林91及三民91同步接獲派遣後出勤前往，報案訊息為40歲女性發生車禍且遭車輛壓過，EMT到達現場初步評估患者無意識無呼吸無脈搏為外科OHCA且無明顯外出血，除常規外科OHCA流程處置外，理學檢查發現右大腿變形及頭部後方有一片血跡，現場人員表示，患者騎乘機車與大貨車發生交通事故，頭部疑似遭貨車輪胎輾過。EMTP臆斷傷病患有頭部創傷合併內出血，除院前給予輸液外，另建立一條給藥途徑，給予1g TXA in 100ml N/S drip 10min，後續送往林口長庚醫院。研究結果（或案例討論）：Physicians' Desk Reference（PDR）將TXA對於TBI的指示如下“用於預防創傷性腦損傷後的顱內出血”但建議使用更小的劑量，有證據表示1g劑量不足以治療嚴重創傷。研究指出，1g劑量在血清濃度中90分鐘後可能無益。但在創傷中，TXA的最佳血清濃度尚未確定。研究人員還發現TXA1g和2g的院前劑量，對於靜脈栓塞的發生率無異，儘管這一項研究指出當前給藥方案的安全性和有效性，但目前給予TXA的建議是基於治療出血，並沒有指出TXA對於TBI的影響。隨著醫療科技的進步，近年來IO技術不再像從前那樣麻煩，在過去的指引中沒有TXA的IO給藥，但沒有已知的骨內給予靜脈藥物的禁忌症。曾經有項在豬模型中的研究，得出了TXA的IO和IV給藥已被證實具有等效的藥物動力學和抗纖維蛋白溶解功效。研究結論（案例研究免填）：由文獻中可知，1g劑量TXA在90分鐘內效果最佳，而台灣111年的平均現場救護時間及平均送醫時間加總僅18.2分鐘，遠低於1g劑量TXA的最佳時效，加上IO技術日漸普及，或許未來在EMS體系中，能從IO給予更多種類的藥物。
並列摘要
Methods (Or case presentation): Upon simultaneous receipt of dispatch, Da-Lin and San-Min proceeded to the incident location immediately. 119 dispatch center indicated that a 40-year-old female involved in a car accident and was run over by a vehicle. Upon arrival, the EMTs found the patient's unconsciousness and absence of breathing and pulse, indicating an out-of-hospital cardiac arrest (OHCA) in the traumatic situation. There was no apparent external bleeding. In addition to following the standard protocol for traumatic OHCA, a physical examination revealed deformity in the right thigh and a pool of blood behind the head. The EMTs suspected that the patient had head injury with potential internal bleeding. Besides established one IV (Intravenous Injection) line, an additional route for medication was established. A dose of 1g of Tranexamic Acid (TXA) with 100ml of normal saline over 10 minutes was administered. Subsequently, the patient was transported to Linkou Chang Gung Memorial Hospital. Results (Or Case Discussion): The Physicians' Desk Reference (PDR) indicates that the use of TXA for traumatic brain injury (TBI) as follows: "Used to prevent intracranial bleeding after traumatic brain injury. However, it is recommended to use reduced dosage. Evidence indicated that a 1g dosage might not be adequate for addressing cases of severe trauma. Previous studies have indicated that the 1g dose might not be adequate in serum concentration after 90 minutes. Nevertheless, the optimal serum concentration of TXA in trauma cases has NOT been determined yet. Researchers also found that no difference of the incidence of venous thromboembolism between prehospital doses of 1g and 2g of TXA. Although previous research suggested the safety and effectiveness of the current administration regimen, the present recommendations for TXA use are based on bleeding control and not specifically address its impact on TBI. In previous guidelines, there was no mention of IO(Intraosseous Injection) administration of TXA, but there are no documented contraindications for intravenous administration of medications through the intraosseous route. A study conducted using pig model that demonstrated the pharmacokinetic and antifibrinolytic effects of TXA through both IO and IV administration are equivalent. Conclusions(NOT for Case study): As indicated by the literatures, a dosage of 1g of TXA demonstrates optimal effectiveness within a 90-minute timeframe. In Taiwan, the average total emergency medical services (EMS) on-scene time and transportation time in 2022 was only 18.2 minutes, which was far below the optimal timeframe for a 1g dose of TXA. Additionally, with the increasing use of IO, it is possible that a greater variety of medications could be administered through the IO route within the EMS system in the future.