氨甲环酸不同给药方式对腰椎手术的失血影响

Effects of tranexamic acid on lumbar surgery by different ways of administration

目的腰椎手术术中及术后使用氨甲环酸可使围手术期失血量减少并降低输血率。通过对术前静脉应用组、单纯伤口内应用组、空白对照组患者进行比较,观察应用氨甲环酸对腰椎手术失血及输血率的影响。方法将初次行腰椎后路三节段以上开放性手术的120例患者随机分为3组各40例,A组术中在切口内局部应用氨甲环酸,B组术前0.5 h静脉滴注氨甲环酸,C组不给予氨甲环酸作为对照。观察各组手术时间、术中失血、术后48 h失血量、输血情况、并发症等。结果 3组术后切口均Ⅰ期愈合。3组间手术时间差异无统计学意义(P>0.05);A组和B组术中失血量和术后48 h失血量少于C组(P<0.05);A组和B组人均输血量少于C组(P<0.05),A组人均输血量少于B组(P<0.05);A组和B组输血例数少于C组,差异有统计学意义(P<0.05);3组间术后并发症发生率差异无统计学意义(P>0.05)。结论腰椎手术应用氨甲环酸能够有效减少术中及术后失血量,降低输血率。

Objective Use of tranexamic acid can reduce perioperative blood loss and decrease the rate of transfusion in the intraoperative and postoperative lumbar spine surgery. To analysis the effects of tranexamic acid on lumbar spine surgery blood loss and transfusion rate by comparing differences among the preoperative intravenous application group, simple application in the wound group and blank control group. Methods A total of 120 patients performed lumbar posterior more than triarticular open operation were divided into 3 groups randomly, 40 patients in each group. Patients with topical application of tranexamic acid in the wound among surgery were belong to group A, patients with intravenous application of tranexamic acid at half an hour before surgery were belong to group B, and patients with no tranexamic acid were belong to group C. Some indicators will be observed, such as time of operation, intraoperative blood loss, postoperative blood loss in 48 hours, condition of the blood transfusion and complication, etc. Results The postoperative incisions of patients significant differences in 3 groups about the in 3 groups were primary healing. There were no t postoperative blood loss in 48 hours in group A Compared to group C, the per capita amount of bl （P〈0.05）, and the amount in group A was less me of operation（P〉0.05）. The amount of and B was less than it in group C（P〈0. 05）. ood transfusion in group A and B was decreased than it in group B（P〈0. 05）. The number of patients with transfusion in group A and B was less than it in group C, and the difference was statistically significant （P〈 0.05）. There were no significant differences in the incidence of complications among 3 groups（P〉0.05）. Conclusion In the lumbar spine surgery, tranexamic acid can reduced the hidden blood loss, intraoperative and postoperative blood loss and blood transfusion rate.