氨甲环酸减少胸腰椎爆裂性骨折围手术期出血的临床研究

Clinical Study on the Reduction of Perioperative Bleeding of Thoracolumbar Burst Fracture with Tricycloic Acid

目的观察氨甲环酸(TXA)在胸腰椎爆裂性骨折围术期出血的疗效与安全性。方法分析我科2011年12月至2016年6月80例伴有神经损伤的胸腰椎单节段爆裂性骨折,男39例,女41例,平均年龄52.3岁,均行后路短节段椎弓根固定、椎管减压处理,所有手术均由同一组医师主刀完成,随机原则平均分为两组,A组为TXA组,TXA组患者手术切皮前30分钟以15mg/kg体质量的初始量,维持量为1mg/kg·h输注方法,B照组为对照组,B组对应时间点以等量生理盐水替代,观察记录两组术中的失血量,手术时间,术中异体红细胞输注情况,术后24h、48h的引流量及术后1天Hb、HCT、APTT、PT、INR、FIB,术后并发症肺栓塞、深静脉血栓发生情况。结果与空白对照组相比,氨甲环酸组患者失血量、术中输血量、术后24h、48h引流量均显著降低,差异有统计学意义(P<0.05),两组PT、APTT、INR、FIB、Hb、HCT差异无统计学意义(P>0.05),术后均无深静脉血栓及肺栓塞发生。结论氨甲环酸能够可以安全有效减少胸腰椎爆裂性骨折围手术期出血,且不增加术后并发症。

Objective To observe the efficacy and safety of tranexamic acid(TXA)in perioperative bleeding of thoracolumbar burst fracture.Methods The clinical data of 80 cases of thoracolumbar single level burst fracture with nerve injury in our department from December 2011 to June 2016 were analyzed,39 males and 41 females with an average age of 52.3 years,and all of them underwent posterior pedicle screw fixation and spinal canal decompression.All operations were performed by the same group of surgeons.They were divided into two groups according to the principle of randomization:Group A was the TXA group,in which the initial dose of 15 mg/kg body weight and maintenance dose of 1 mg/kg·h were infused 30 minutes before skin incision;Group B as control group,the patients in this group were replaced with the same amount of saline at the corresponding time point.The amount of blood loss during operation,the time of operation,the transfusion of allogeneic red blood cells,the drainage flow at 24 hours and 48 hours after operation,the amount of Hb,HCT,APTT,PT,INR and FIB 1 day after operation,and the incidence of complications like pulmonary embolism and deep vein thrombosis were observed and recorded in the two groups.Results Compared with the blank control group,the amount of blood loss,the amount of blood transfusion during operation and the drainage flow at 24h and 48h after operation were all significantly decreased in the group of amacylic acid(P<0.05);There was no significant difference in PT、APTT、INR、FIB、Hb and HCT between the two groups(P>0.05);No deep venous thrombosis or pulmonary embolism occurred after operation.Conclusion Tranexamic acid can safely and effectively reduce perioperative bleeding of thoracolumbar burst fractures without increasing postoperative complications.