氨甲环酸单独与氨甲环酸联合流体明胶用于退行性腰椎滑脱患者围术期止血的效果比较

TXA alone versus TXA+Surgiflo for perioperative hemostasis in patients with degenerative lumbar spondylolisthesis

目的对比氨甲环酸(tranexamic acid,TXA)与TXA联合流体明胶(Surgiflo)用于减少退行性腰椎滑脱患者围术期出血的效果。方法分析2013年3月-2017年3月联勤保障部队第九八一医院骨科收治的65例退行性腰椎(L4)滑脱患者的临床资料。TXA组32例,男性13例,女性19例,平均年龄(59.96±7.52)岁;TXAS(TXA+Surgiflo)组33例,男性15例,女性18例,平均年龄(61.00±6.33)岁。比较两组术前收缩压、术前凝血指标、围术期血红蛋白量、手术时间、术中出血量、3 min及5 min止血成功率、止血3 min内引流量、自体血回输例数、术后引流量以及拔除引流管时间。结果两组基础资料包括年龄、性别以及术前血红蛋白、收缩压和凝血指标差异无统计学意义(P>0.05)。TXAS组3 min及5 min止血成功率高于TXA组(3 min:63.64%vs 34.48%;5 min:93.94%vs 65.63%;P均<0.05);TXAS组止血3 min内的引流量[(43.33±23.05)ml vs(60.72±25.73)ml],术中出血量[(190.61±62.42)ml vs(219.90±53.61)ml]以及术后第1天和第2天引流量[(276.48±52.53)ml vs(301.03±45.16)ml,(100.97±20.02)ml vs(113.56±22.66)ml]均显著低于TXA组(P均<0.05)。TXA组自体血回输15例(46.88%),多于TXAS组的5例(15.15%)(P=0.006)。两组术后第1天和第4天血红蛋白量、术后第3天引流量、手术时间以及拔除引流管时间差异无统计学意义(P>0.05)。结论TXA与Surgiflo联合使用较单独使用TXA更有助于减少围术期的出血量,减少术后输血需求,同时可以在术中更快止血。

Objective To compare the effect of tranexamic acid(TXA)alone versus TXA+Surgiflo for perioperative hemostasis in patients with degenerative lumbar spondylolisthesis.Methods Clinical data about 65 patients with degenerative lumbar(L4)spondylolisthesis admitted to Joint Service Support Force 981 Hospital from March 2013 to March 2017 were retrospectively analyzed.There were 32 patients in TXA group,including 13 males and 19 females,with average age of(59.96±7.52)years.Another 33 patients were in TXAS(TXA+Surgiflo)group,including 15 males and 18 females,with average age of(61.00±6.33)years.Preoperative systolic pressure(SP)and coagulation indicators,perioperative hemoglobin(HGB),surgical duration(SD),blood loss(BL),success rate of hemostasis(SRH)at 3mins and 5 mins,bleeding volume during hemostasis(BVH)in 3 mins,number of autologous blood transfusion(ABT),postoperative drainage volume(PDV)as well as duration of tube drainage(DTD)were recorded.Results There was no statistically significant difference in general characteristics,including age,gender and preoperative HGB,SP or coagulation indicators between the two groups.SRH at 3mins and 5 mins(3 min:63.64%vs 34.48%;5 min:93.94%vs65.63%;P<0.05,respectively),BVH at 3 mins([43.33±23.05]ml vs[60.72±25.73]ml),blood loss([190.61±62.42]ml vs[219.90±53.61]ml),PDV at 1 d,2 d(1 d:[276.48±52.53]ml vs[301.03±45.16]ml;2 d:[100.97±20.02]ml vs[113.56±22.66]ml)in the TXAS group were superior to the TXA group(all P<0.05).There were 15 cases(46.88%)with autotransfusion in the TXA group,which was greater than that in the TXAS group(5 cases,15.15%).No statistically significant difference was found in PDV of 3 d,HGB of postoperative 1 d,4 d,SD or DTD between the two groups.Conclusion TXA+Surgiflo show more advantages in perioperative hemorrhage control,less requirement of postoperative blood transfusion and faster hemostasis in the surgery than TXA alone.