负荷剂量氨甲环酸对脊柱侧弯手术的影响

目的探讨负荷剂量氨甲环酸（TXA）对行脊柱侧弯手术患者的出血量、血常规、凝血功能等的影响。方法择期拟行脊柱侧弯矫形术患者50例，年龄18-60岁，体重40-80kg，ASA分级Ⅰ-Ⅱ级。随机分为氯化钠注射液组（Ⅰ组）和TXA组（Ⅱ组），每组各25例。Ⅰ组：切皮后10min静脉滴ii0．9％氯化钠注射液100ml。Ⅱ组：切皮后10min静脉滴注TXA 1g。记录术中出血量、自体血回输量、异体输血量、新鲜冰冻血浆用量、术后第一天引流量；记录术前及术后第1天血常规、凝血功能的变化；记录术后1周超声检查深静脉血栓和并发症的情况。结果两组术中出血量、异体输血量、新鲜冰冻血浆差异均无统计学意义（P〉0．05）；术后第1天引流量Ⅱ组明显少于Ⅰ组（P〈0．05）；Ⅱ组血红蛋白变化量较Ⅰ组小（P〈0．05），白细胞、血红蛋白、血小板两组差异无统计学意义（P〉0．05）；PT、APTT、INR、D2聚体两组差异无统计学意义（P〉0．05）。两组术后均未出现下肢深静脉血栓及肺栓塞等并发症。结论在脊柱侧弯矫形手术中，单纯负荷剂量的TXA可以有效减少伤口渗出，减少术后引流量。

Objective The aim of this study was to discuss loading dose tranexamic acid （ TXA ） effect on patients with blood loss, blood routine, coagulation function, etc. of the scoliosis surgery. Methods Fifty patients who were scheduled to undergo elective surgery under general anaesthesia were investigated, 18 to 60 years old, 40-80kg weight, ASA class Ⅰ-Ⅱ. By random grouping, patients can be divided into normal saline group （ group Ⅰ） and TXA group （ group Ⅱ） , 25 cases in each group. Group Ⅰ： intravenous drip 100 ml 0.9% saline water after cut skin 10 min. Group Ⅱ： intravenous drip TXA 1 g after cut skin 10 min. Record the Bleeding, the autologous blood back to the throughput, the allogeneic blood transfusion volume, the volume of fresh frozen plasma, the lead flow of first postoperative day; Record the routine blood and clotting function changes of preoperative and postoperative; Record deep vein thrombosis by ultrasound and postoperative complications for one week. Results There was no significant difference between group Ⅰ and group Ⅱ in the volume of intraoperative blood loss, allogeneie blood transfusion and fresh frozen plasma （ P〉0.05 ） . Group Ⅱ less than group Ⅰ in volume of drainage significantly on the first postoperative day （ P〈0.05 ） . The hemoglobin variation of group II is less than group Ⅰ relatively （ P〈0.05 ） , there was no statistically significant difference between two groups in white blood cells, hemoglobin, platelet （ P〉0.05 ） ; PT, APTT, INR, D-D has no statistically significant difference between the two groups （ P〉0.05 ） . Two groups did not appear lower extremity deep venous thrombosis and pulmonary embolism etc. Conclusion In scoliosis surgery, loading dose TXA can reduce the wound and postoperative flow effectively