氨甲环酸在腰椎后路融合术中应用的临床研究

A Clinical study on the Application of Tranexamic Acid in Posterior Lumbar Fusion

目的探讨氨甲环酸静脉在减少腰椎后路融合术围手术期失血量中应用的有效性及安全性。方法选择2013年3月-2014年3月收治的68例退变性腰椎管狭窄症伴腰椎不稳行手术治疗的患者。根据术中是否使用氨甲环酸分为氨甲环酸组(n=36)和对照组(n=32)。氨甲环酸组麻醉诱导后静脉滴注氨甲环酸,对照组术中未使用促凝药物。比较术前及术后红细胞计数、血红蛋白量、血细胞比容、凝血酶原时间、活化部分凝血酶时间、纤维蛋白原、术中失血量、术后引流量、输血人数及输血量。比较氨甲环酸组和对照组中肺栓塞及深静脉血栓形成例数。结果两组患者术中失血量差异无统计学意义,术后引流量氨甲环酸组少于对照组(P<0.05),术后红细胞计数、血红蛋白量、血细胞比容,氨甲环酸组大于对照组(P<0.05)。两组患者术前、术后凝血酶原时间、活化部分凝血酶时间及纤维蛋白原比较,无统计学意义(P>0.05)。两组患者术后未发现肺栓塞及深静脉血栓形成。结论在腰椎后路融合术中静脉应用氨甲环酸安全有效,能显著减少术后失血量,且不增加肺栓塞及深静脉血栓形成的风险。

Objective To discuss the effectiveness and safety of intravenous application of tranexamic acid in reducing the blood loss in the perioperative period of lumbar fusion surgery.Methods A retrospective study of 68 patients with degenerative lumbar spinal stenosis with lumbar instability who were treated with lumbar fusion surgery from March 2013 to March 2014 in West China Hospital was carried out.The patients were divided into tranexamic acid group and control group according to whether tranexamic acid was used.After induction of anesthesia,tranexamic acid was given by intravenous drop to patients in the tranexamic acid group,while the control group did not receive any hemostatic drug.The red blood cell count,hemoglobin,mean corpuscular volume,prothrombin time,activated partial thromboplastin time,fibrinogen metaglobulin,intraoperative blood loss,postoperative blood loss,and blood transfusion volume before and after operation were compared.And we also observed whether there was pulmonary embolism or deep vein thrombosis incident.Results It showed no significant difference in intraoperative blood loss between the two groups,but the tranexamic acid group had less blood loss after operation than that of the control group（ P 〈0.05）.The tranexamic acid group had a higher red blood cell count,hemoglobin and mean corpuscular volume after operation than that of the control group（ P 〈0.05）.There was no significant difference between the two groups in prothrombin time,activated partial thromboplastin time,fibrinogen metaglobulin before and after operation（ P 〉0.05）.The pulmonary embolism and deep vein thrombosis were not found in the two groups.Conclusions Intravenous application of tranexamic acid is safe and effective in posterior lumbar fusion surgery.It can reduce the postoperative blood loss significantly,without increasing the risk of pulmonary embolism and deep vein thrombosis.