静脉滴注氨甲环酸在脊柱手术中的应用效果

Effects of intravenous drip of tranexamic acid in spinal surgery

目的探讨静脉滴注氨甲环酸在脊柱手术中的应用效果。方法选取2017年1月至2019年12月周口协和骨科医院脊柱外科行脊柱手术患者128例,根据随机数字表法分为对照组及观察组,每组64例。对照组切皮前静脉滴注生理氯化钠溶液,观察组静脉滴注氨甲环酸。观察比较两组血栓弹力图指标、D-二聚体(D-D)水平、凝血五项[活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)、凝血酶原时间(PT)及国际标准化比值(INR)]及术后引流量。结果术后第1天,观察组血栓最大幅度高于对照组(P<0.05);术前及术后第2、3天,两组血栓最大幅度比较差异未见统计学意义(P>0.05)。两组手术前后反应时间、凝固时间、凝固角及纤溶活动值比较差异均未见统计学意义(P均>0.05)。术前,两组D-D水平比较差异未见统计学意义(P>0.05);术后第1、2、3天,观察组D-D水平均低于对照组(P均<0.05)。两组APTT、PT、TT、FIB、INR等指标手术前后比较差异均未见统计学意义(P均>0.05)。术后第1、2、3天,观察组引流量低于对照组(P<0.05)。结论静脉滴注氨甲环酸可有效提高脊柱手术患者血栓最大幅度,降低血浆D-D水平,对机体凝血功能无影响,降低术后引流量,有助于促进术后康复。

Objective To investigate the effects of intravenous drip of tranexamic acid in spinal surgery.Methods A total of 128 patients with spinal surgery in Zhoukou Union Medical College Orthopedic Hospital from January 2017 to December 2019 were enrolled,and they were divided into the control group and observation group by random number table methods,with 64 cases in each group.Patients in control group received intravenous drip of saline,and patients in observation group received intravenous drip of tranexamic acid.Then the thromboelastography index,D-dimer(D-D)level,coagulation indicators,such as activated partial prothrombin time(APTT),fibrinogen(FIB),thrombin time(TT),prothrombin time(PT),international normalized ration(INR)and postoperative drainage were compared between the two groups.Results On the first day after operation,the maximum thrombus amplitude in observation group was higher than that in control group(P<0.05).There was no significant difference between the two groups in the maximum extent of thrombus before and 2,3 days after operation(P>0.05).There was no significant difference in response time,coagulation time,coagulation angle and fibrinolytic activity between the two groups before and after operation(all P>0.05).Before operation,there was no significant difference in D-D level between the two groups(P>0.05);on the 1st,2nd and 3rd days after operation,the D-D level of the observation group was lower than that of the control group(P all<0.05).There was no significant difference in APTT,PT,TT,FIB and INR between the two groups before and after operation(P all>0.05).On the 1st,2nd and 3rd days after operation,the drainage volume of the observation group was lower than that of the control group(P<0.05).Conclusions Intravenous drip of tranexamic acid in spinal surgery can effectively increase the maximum amplitude of thrombosis,reduce plasma D-D levels,with no impair on coagulation function.And it can lower postoperative drainage and promote postoperative recovery.