氨甲环酸结合术后引流管夹闭在脊柱侧凸矫形术中的应用

Application of tranexamic acid combined with postoperative drainage tube clipping in scoliosis correction

目的评估静脉应用氨甲环酸结合术后引流管夹闭降低脊柱侧凸围手术期失血量的有效性与安全性。方法采用后路钉棒系统矫形固定、椎板小关节处植骨、未进行截骨矫形治疗的58例特发性脊柱侧凸患者,随机分为两组,试验组手术前15 min静脉注入15 mg/kg氨甲环酸,术中静脉予以10 mg/(kg·h)维持至术毕,术后夹闭引流管8 h;对照组术前15 min输注等量生理盐水,术中予以等量生理盐水,术后夹闭引流管8 h。比较两组术后24 h引流量、总引流量、自体血回输量、异体输血率、置管时间和术后1、3、7 d血红蛋白值及术后伤口感染率等指标。结果试验组术后引流量、总引流量、自体血回输量、输血率、置管时间均较对照组明显降低;术后1~7 d,试验组血红蛋白均较对照组明显提升(P<0.05)。结论静脉应用氨甲环酸结合术后引流管夹闭8 h,可有效、安全控制脊柱侧凸矫形术围手术期出血量。

Objective To evaluate the efficacy and safety of the application of tranexamic acid combined with postoperative drainage tube clipping in reducing blood loss in the perioperative period of scoliosis correction. Mediods A total of 58 patients with idiopathic scoliosis treated with posterior screw rod system orthopedic fixation and bone graft at facet joint but not treated with osteotomy were selected and randomly divided into an experiment group and a control group. The experiment group was treated with 15 mg/kg tranexamic acid by intravenous injection 15 min before the operation and maintained at 10 mg/（kg＊h） during operation till the end of operation, after which the drainage tube was clipped for eight hours; the control group was treated with equivalent normal saline 15 min before and during the operation, after which the drainage tube was clipped for eight hours. The volume of drainage 24 hours after the operation, the total volume of drainage, autologous blood transfusion amount, allogeneic blood transfusion rate, indwelling catheter time and hemoglobin value one day, three days and seven days after the operation, and postoperative wound infection rate and other indexes between the two groups were compared. Results The postoperative volume of drainage, the total volume of drainage, autologous blood transfusion amount, blood transfusion rate and indwelling catheter time in the experiment group were much lower than those in the control group; the hemoglobin value 1 -7 days after the operation was significantly higher than that in the control group （P 〈 0.05）. Conclusion Tranexamic acid administered intravenously combined with postoperative clipping of drainage tube for eight hours can effectively and safely control the blood loss in the perioperative period of scoliosis correction.