急性等容血液稀释联合氨甲环酸应用于腰椎融合术血液管理的临床疗效观察

Clinical observation of acute normovolemic hemodilution combined with tranexamic acid in blood management of lumbar spinal fusion surgery

目的探讨急性等容血液稀释(acute normovolemic hemodilution,ANH)式自体输血联合氨甲环酸(tranexamic acid,TXA)在腰椎融合手术中的有效性。方法选取2013年6至2019年12月首都医科大学附属北京世纪坛医院行腰椎退行性病变的多节段后路脊柱融合术患者160例。根据血液管理策略分为ANH组、TXA组、ANH联合TXA组和对照组,每组各40例。比较4组术中出血量、术后引流量、手术结束时和术后第1天的Hb和Hct、术中和术后异体输血量和输血率。结果160例患者中男83例,女77例,年龄55~70岁,平均(59.3±7.8)岁。TXA组、ANH联合TXA组术中出血量和术后引流量均低于对照组和ANH组;ANH联合TXA组的术中异体输血量、术后异体输血量及术后异体输血率均显著低于ANH组、TXA组、对照组,术中异体输血率方面,ANH联合TXA组显著低于TXA组和对照组,差异均有统计学意义(P<0.05)。结论ANH联合TXA能够减少手术出血量、异体输血量与异体输血率,是降低腰椎融合术患者出血量和异体输血率的有效血液管理策略。

Objective To explore the effectiveness of acute normovolemic hemodilution(ANH)autotransfusion combined with tranexamic acid(TXA)in lumbar spinal fusion surgery.Methods A total of 160 patients with lumbar degenerative diseases underwent multilevel posterior spinal fusion in Beijing Shijitan Hospital affiliated to Capital Medical University from June 2013 to December 2019 were selected.According to the blood management strategy,patients were divided into ANH group,TXA group,ANH combined with TXA group and control group,with 40 cases in each group.The intraoperative blood loss,postoperative drainage,Hb and Hct at the end of operation and the first day after operation,intraoperative and postoperative allogeneic blood transfusion and blood transfusion rate were compared among the four groups.Results Among the 160 patients,there were 83 males and 77 females,aged from 55 to 70 years,with an average age of(59.3±7.8)years.The intraoperative blood loss and postoperative drainage in TXA group and ANH combined with TXA group were lower than those in control group and ANH group.The intraoperative allogeneic transfusion volume,postoperative allogeneic transfusion volume,and postoperative allogeneic transfusion rate of the ANH combined with TXA group were significantly lower than those of the ANH group,TXA group,and control group.In terms of intraoperative allogeneic transfusion rate,the ANH combined with TXA group was significantly lower than those of the TXA group and control group with statistical significance(P<0.05).Conclusions ANH combined with TXA can reduce the amount of bleeding,allogeneic blood transfusion and allogeneic blood transfusion rate,which is an effective blood management strategy to reduce the amount of bleeding and allogeneic blood transfusion rate in patients undergoing lumbar spinal fusion surgery.