氨甲环酸对腰椎后路手术后减少出血的效果观察

Effect of tranexamic acid on reducing postoperative blood loss in posterior approach lumbar surgery

目的评估氨甲环酸减少腰椎后路手术治疗退变性腰椎管狭窄术后出血的效果。方法60例退变性腰椎管狭窄症患者随机分为氨甲环酸组及对照组,氨甲环酸组术前静脉应用氨甲环酸15 mg/kg,对照组术前应用0.9%氯化钠,所有的患者均行椎弓根螺钉固定,然后行腰椎后路减压植骨融合术。比较术中及术后两组的出血量,观察应用氨甲环酸的并发症。结果两组在年龄、性别、体重指数及手术时间无显著性差异,术中出血量无显著性差异。但是氨甲环酸组术后出血量明显低于对照组。特别是在术后12 h内,两组无静脉血栓或其他并发症的发生。结论术前应用单剂量氨甲环酸能显著减少腰椎后路手术术后失血,并且无明显的副反应。

Objective To investigate the effect of tranexamic acid （TXA） on reducing postoperative blood loss in posterior approach lumbar surgery for degenerative lumbar stenosis. Methods Sixty patients with degenerative lumbar instability with stenosis were randomly divided into TXA group and control group, received 15 mg/kg body weight of TXA or placebo （0.9 % sodium chloride solution） intravenously, respectively, before the skin incision was made. The operation of pedicle screw fixation was performed for all patients, and then selective laminectomy and posterior lumbar interbody fusion were carried out. Intraoperative and postoperative blood loss were compared between the two groups. And the complication of TXA was also investigated. Resets There were no statistically significant differences between the two groups in age, sex, body mass index and operation time. There was no significant difference in intraoperative blood loss between the two groups. However, in the TXA group, postoperative blood loss was significantly lower than that in the control group. Especially, postoperative blood loss during the first 12 h was reduced as compared to the control group. There were no thromboembolic events or other complications occurred in two groups. Conclusion Preoperative single-dose TXA can significantly reduce postoperative blood loss in posterior approach lumbar surgery, and there are no significant side effects.