多次静脉氨甲环酸对胸腰椎骨折术后早期的影响

Effect of multiple intravenous infusions of tranexamic acid on early clinical outcomes of surgical treatment for thoracolumbar fractures

[目的]探讨多次静脉应用氨甲环酸(TXA)对胸腰椎骨折术后早期结果的影响。[方法] 85例胸腰椎单节段骨折患者随机分为两组,均行后路切开复位、短节段内固定手术。其中TAX组43例,术前、术后多次静脉给予TAX,而对照组42例,相应时间点给予生理盐水。比较两组早期临床效果。[结果]两组患者均顺利完成手术。术后两组患者均未出现下肢深静脉血栓形成及血栓相关并发症发生。两组患者手术时间和术后住院日的差异无统计学意义(P>0.05),但是TAX组在术中出血量、术后48 h引流量、引流管拔管时间、输血量和输血率方面均显著优于对照组(P<0.05)。随时间推移,两组患者VAS和ODI评分均显著减少(P<0.05),相应时间点,两组间VAS和ODI评分的差异无统计学意义(P>0.05)。[结论]围手术期多次静脉应用氨甲环酸在不增加血栓性疾病风险的前提下,明显减少胸腰椎骨折患者围手术期出血和输血。

[Objective] To explorer the effect of multiple intravenous infusions of tranexamic acid(TXA) on the early clinical outcomes of surgical treatments for thoracolumbar fractures. [Methods] A total of 85 patients who underwent open reduction and internal fixation with short-segment pedicle screw for thoracolumbar fractures were enrolled into this study and divided into two groups randomly. Of them, 43 patients in the TXA group received multiple intravenous infusions of TXA perioperatively, while 42 patients in the control group received normal saline at corresponding time points. The documents related to the early clinical outcomes were compared between the two groups. [Results] All the patients in both groups had operation performed smoothly without deep venous thrombosis of the low extremities or thrombotic events happened in anyone of them. Although there were no statistical differences in operation time and hospital stay postoperatively between them(P>0.05), the TAX group proved significantly superior to the control group regarding to the intraoperative blood loss, drainage volume at 48 hours after operation, the time to remove drainage tube, blood infusion volume and ratio(P<0.05). As time went, the VAS and ODI scores in both group significantly decreased(P<0.05), however, no statistically significant differences in aforesaid scores were proven at any matching time point between the two group(P>0.05). [Conclusion] The multiple intravenous infusions of tranexamic acid do reduce the perioperative blood loss and transfusion requirements in surgical operations for thoracolumbar fractures without increase of the risk of thrombotic complications.