术前静脉应用氨甲环酸对经皮椎弓根螺钉固定胸腰椎骨折手术隐性失血量影响的前瞻性研究

Effect of intravenous tranexamic acid on perioperative hidden blood loss in percutaneous pedicle screw fixation for thoracolumbar fractures

目的观察术前静脉滴注氨甲环酸（TXA）对经皮椎弓根螺钉固定胸腰椎骨折手术失血量的影响及安全性。方法采用前瞻性随机对照研究将2017年1月至2017年12月收治的113例拟行经皮椎弓根螺钉固定的胸腰椎骨折患者随机分为试验组（58例，术前30min静脉滴注氨甲环酸15mg／kg）和对照组（55例，术前30min使用生理盐水作为安慰剂），记录比较两组患者术后24h理论失血总量、隐性失血量、D-二聚体、下肢深静脉血栓形成（DVT）及其他并发症的发生情况。结果最终试验组有54例患者，对照组有50例患者纳入研究。试验组患者术后24h理论失血总量[（319．0±140．5）mL]、隐性失血量[（242．0±143．4）mL]低于对照组[（418．7±188．1）mL、（354．7±181．9）mL]，差异有统计学意义（P〈0．05）。两组患者间手术时间和术中出血量比较差异均无统计学意义（P〉0．05）。两组术后D．二聚体均高于术前，差异有统计学意义（P〈0．05）。两组患者术后均无DVT及其他血栓事件发生。结论术前静脉滴注氨甲环酸可明显减少经皮椎弓根螺钉胸腰椎骨折手术隐性失血量，且不增加血栓事件的风险。

Objective To investigate the effect of intravenous tranexamic acid （TXA） on periop- erative hidden blood loss in percutaneous pedicle screw fixation for thoracolumbar fractures. Methods A prospective study was conducted in the 113 patients who would be subjected to percutaneous pedicle screw fixation for thoracolumbar fracture from January 2017 to December 2017. They were randomly assigned into an observation group （ n = 58） receiving intravenous drip of 15 mg/kg TXA 30 minutes preoperation or a control group （ n = 55） receiving intravenous drip of normal saline solution 30 minutes preoperation. The total blood loss and hidden blood loss 24 hours postoperation, D-dimer volume, incidences of deep vein thrombosis and other complications were recorded and compared between the 2 groups. Results There were 54 patients in the observation group and 50 patients in the control group for statistic analysis. The observation group had significantly less total blood loss （319. 0 ± 140. 5 mL） and hidden blood loss （242.0 ± 143.4 mL） 24 hours postoperation than the control group （418.7 ± 188.1 mL and 354. 7 ± 181.9 mL, respectively） （ P 〈 0. 05）. There were no significant differences between the 2 groups in operation time or intraoperative blood loss （ P 〉 0. 05） . The volume of postoperative D-dimer was significantly higher than the preoperative value in both groups （ P 〈 0. 05）. No thromboembolic events occurred in either group. Conclusion Intravenous TXA may significantly reduce intraoperative hidden blood loss with no increased rik of thromboembolic events in percutaneous pedicle screw fixation for thoracolumbar fractures.