腰椎退变性侧弯术中局部与静脉应用氨甲环酸

Local and intravenous administration of tranexamic acid in surgical procedure for degenerative lumbar scoliosis

[目的]观察切口局部联合静脉多次应用氨甲环酸对腰椎退变性侧弯手术失血量及安全性的影响。[方法] 2015年4月~2019年4月,97例腰椎退变性侧弯患者纳入本研究,随机分三组。空白组32例,不应用TXA;静脉组33例,术前30 min静脉滴注TXA 15 mg/kg;联合组32例,术前30 min静脉滴注TXA 15 mg/kg+术后切口内灌注TXA 1.0 g溶液10 ml+术后6 h重复静脉滴注TXA 15 mg/kg。比较三组围手术期临床与辅助检查资料。[结果]三组手术时间及固定融合的腰椎节段数差异无统计学意义(P>0.05)。联合组和静脉组术中出血量、自体血回输量及异体红细胞输入量均显著少于空白组(P<0.05)。联合组术后引流量和术后隐性失血量显著少于静脉组和空白组(P<0.05)。三组患者术后Hb均显著低于术前(P<0.05)。术后24 h和72 h,联合组Hb显著高于静脉组和空白组(P<0.05)。术后三组患者的D-二聚体均高于术前(P<0.05)。超声检查显著三组间肌间血栓发生的差异无统计学意义(P>0.05)。[结论]切口局部联合静脉多次应用氨甲环酸可以明显减少DLS患者围手术期总失血量,而不增加深静脉血栓风险。

[Objective]To explore the effect of local and repeated intravenous administration of tranexamic acid(TXA)on blood loss and safety in operation for degenerative lumbar scoliosis(DLS).[Methods]From April 2015 to April 2019,a total of97 patients who were undergoing surgical treatment for DLS were enrolled into this study,and randomly divided into three groups.Among them,32 patients in the blank group had no TXA given during perioperative period,33 patients in the intravenous group received 15 mg/kg TXA intravenously at 30 minutes before operation,while 32 patients in the combined group were given 15 mg/kg TXA intravenously at 30 minutes before operation,local administration of TXA 1.0 g in 10 ml normal saline into the incision at end of operation,and 15 mg/kg TXA intravenously at 6 hours after operation.The clinical and laboratory test data were compared among the 3 groups.[Results]There were no significant differences in operation time and the number of lumbar segments involved among the three groups(P>0.05).The combined group and the intravenous group had significantly less intraoperative blood loss,autotransfusion and allotransfusion than the blank group(P<0.05).Additionally,the combined group had significantly less postoperative drainage and postoperative hidden blood loss than the blank group and the intravenous group(P<0.05).With respect to lab tests,the hemoglobin(Hb)significantly decreased after operation in all the 3 groups compared those before operation(P<0.05),and the combined group remained significantly higher Hb than the blank group and the intravenous group at 24 hours and 72 hours postoperatively(P<0.05).The D-dimer significantly rose postoperatively in all the 3 groups with contrast to those before operation(P<0.05).Furthermore,the occurrence of intramuscular thrombosis revealed the ultrasound scanning was not statistically significant among the 3 groups(P>0.05).[Conclusion]The local and repeated intravenous administration of tranexamic acid does significantly reduce the total blood loss during perioperative period for DLS without increasing risk of deep vein thrombosis.