氨甲环酸浸渍明胶海绵对腰椎手术患者术后出血的影响

Effects of tranexamic acid impregnated gelatin sponge on postoperative bleeding after multi-segment lumbar vertebra surgery

背景:腰椎手术相关并发症的防治逐渐得到重视,但如何减少术后引流量较大导致的输血及住院时间延长鲜有报道。目的:探讨氨甲环酸(TXA)浸渍可吸收明胶海绵局部止血对腰椎多节段手术患者术后引流量及住院时间的影响。方法:本前瞻、随机对照研究纳入2013年7月至2014年12月行双节段腰椎后路减压融合术的患者80例。在关闭切口前随机将浸有氨甲环酸的明胶海绵应用于腰椎显露伤口中(试验组)或不做该止血措施(对照组)。手术均由同一主刀医师完成。比较两组术后总引流量、引流终止时间、术后住院时间、再入院人数及术后并发症。结果:共73例患者完成本研究,试验组35例,对照组38例。两组患者年龄、性别、体重指数、手术时间、术中失血量、术中输血例数、术中输血量无显著差异(P>0.05)。试验组的术后平均总引流量、引流时间及术后平均住院时间均显著少于对照组([213±127]ml vs[329±152]ml,[2.5±0.3]d vs[3.5±0.3]d,[3.1±0.7]d vs[4.1±0.7]d,P<0.05)。两组病例在出院后30 d内未出现局部用药相关的不良反应,未发现因相关并发症再入院者。结论:腰椎多节段手术中采用氨甲环酸浸渍可吸收明胶海绵止血可显著减少术后引流量,并缩短患者住院时长。

Background： The prevention and treatment of the complications of lumbar operation was gotten attention gradually. But how to reduce the postoperative wound volume of drainage and shorten the hospitalization time was reported rarely. Objective：To investigate clinical outcome of tranexamic acid （TXA） impregnated absorbable gelatin sponge for postopera-tive stop bleeding and hospitalization time in patients with surgical treatment of lumbar vertebrae. Methods： The consecutive 80 patients undergoing two-segment lumbar posterior decompression and intervertebral fusion from July 2013 to December 2014 were enrolled in this prospective random controlled study. TXA impregnated absorbable gelatin sponge was applied in the lumbar wound in experiment group before suture, while the patients in control group were not given. All the surgeries were performed by the same surgeon. The total volume of postoperative drainage, terminal time of postoperative drainage, postoperative hospital stay, the number of readmission and postoperative complications were compared between the two groups. Results：A total of 73 patients were followed up and enrolled in this study, including 35 in the experimental group and 38 in the control group. There were no significant differences in terms of age, sex, body mass index （BMI）, operation time, intra-operative blood loss, or intraoperative blood transfusion volume between groups （P〉0.05）. Postoperative total volume of drainage, drainage duration and postoperative hospital stay in the experimental group were significantly less than those in the control group （[213×127] ml vs [329×152]ml, [2.5×0.3]d vs [3.5×0.3]d, [3.1×0.7]d vs [4.1×0.7]d, P〈0.05）. No TXA re-lated adverse reactions or readmission occurred in 30 d after discharge. Conclusions：TXA impregnated absorbable gelatin sponge can significantly reduce drainage and shorten hospitalization stay after multi-segment lumbar surgery.