氨甲环酸减少青少年特发性脊柱侧凸后路融合固定术失血的临床研究

Clinical study of tranexamic acid decreasing operative blood loss during posterior spinal fusion for treatment of adolescent idiopathic scoliosis

目的评价氨甲环酸(TXA)在青少年脊柱侧凸后路融合固定手术中控制出血量的有效性及安全性。方法选取因青少年脊柱侧凸行后路融合固定术的患者93例,TXA组43例,术中使用TXA(先给予1 g负荷剂量,然后按100 mg/h维持剂量给药),对照组50例,术中未使用TXA或其他抗纤溶药。比较2组的术中及术后临床指标。结果 TXA组术中失血量低于对照组[(703±176)m L vs(1 143±389)m L],术后引流量低于对照组[(145±75)m L vs(278±95)m L]。TXA组患者术中自体血回收量低于对照组[(241.0±109.1)m L vs(372.7±123.0)m L],回输量也少于对照组[(189.6±84.1)vs(302.1±96.0)]。未见明显并发症。TXA组无输异体血者,对照组1例输异体血400 m L。结论青少年特发性脊柱侧凸后路固定融合手术中静脉应用TXA可以有效减少术中失血和输血量,不增加术中及术后并发症。

Objective To assess the efficacy and safety of tranexamic acid （TXA） in decreasing operative blood loss and the need for transfusion during posterior spinal fusion for the treatment of idiopathic scoliosis in adolescents. Methods A retrospective comparative analysis of 93 consecutive adolescents undergoing posterior spinal fusion procedures was performed. Patients were divided into treatment group （TXA, n=43） and control group （n=50）. Clinical indicators were compared in operation and after operation between two groups. Results There was significantly less operative blood loss （703±176） mL in TXA group than that of control group （1143±389） mL. And post operation flow was also lower in TXA group than that of control group [（145 ± 75）mL vs （278 ± 95） mL, P〈0.001）]. Autologous blood recovery in patients was lower in TXA group than that of control group [（241.0±109.1） mL vs （372.7±123.0） mL, P〈0.001）. There were no major intraoperative complications in two groups. There was no blood transfusion in TXA group, and there was 1 case with 400 mL blood transfusion in control group. Conclusion TXA treatment can decrease blood loss and blood transfusion and not increase intraoperative and postoperative complications in surgery of posterior spinal fusion of adolescent idiopathic scoliosis.