氨甲环酸局部冲洗联合静脉滴注在腰椎后路手术中的应用价值

Application Value of Local Irrigation Combined with Intravenous Infusion of Tranexamic Acid in Posterior Lumbar Spine Surgery

【目的】探讨氨甲环酸(Tranexamic acid,TXA)局部冲洗联合静脉滴注在腰椎后路手术中的应用价值。【方法】回顾性分析2018年11月至2019年9月在本院行腰椎后路手术的96例腰椎退行性病变患者的临床资料,根据是否使用TXA分成联合使用组(TXA局部冲洗联合静脉滴注)、局部使用组(TXA局部冲洗)和空白对照组(静脉和局部均不使用TXA),每组32例。比较三组术前、术后血红蛋白(Hb)值、血浆D-二聚体(D-D)值及日本骨科协会评分(Japanese Orthopaedic Association scores,JOA),记录术中出血量、手术时间、Fromme手术视野质量评分及术后引流量,计算总失液量,评估TXA对手术失血量、术中视野评分及手术疗效情况。【结果】所有患者术后均获得6个月的随访。联合使用组术中出血量、术后引流量、总失液量、手术时间及手术视野评分均低于局部使用组,而局部使用组低于空白对照组,其差异均有统计学意义(P<0.05)。三组术前、术后血浆D-D差异均无统计学意义(P>0.05),联合使用组术后Hb值高于局部使用组,而局部使用组高于空白对照组,差异均有统计学意义(P<0.05)。联合使用组患者JOA评分改善率为72.9%,与局部使用组的70.5%及空白对照组的69.6%比较差异无统计学意义(P>0.05)。联合使用组患者置钉、减压时手术视野评分均明显低于局部使用组,而局部使用组低于空白对照组,其差异均有统计学意义(P<0.05)。三组患者术后2周均行双下肢静脉彩超检查,均未发生深静脉血栓;三组患者术后均未出现肺栓死、脑脊液漏、脑梗塞、癫痫等并发症。【结论】术中静脉联合局部使用TXA可降低腰椎后路手术患者总体失血量,改善术中视野评分,减少手术时间,值得临床推广应用。

【Objective】To explore the initial effect of local irrigation of tranexamic acid(TXA)combined with intravenous administration of TXA in posterior lumbar spine surgery.【Methods】Retrospective analysis was performed on the clinical data of patients undergoing lumbar posterior approach surgery from November 2018 to September 2019.According to the use of TXA,they were divided into the Combined use group(local irrigation com-bined intravenous infusion of TXA),the local use group(local use of TXA alone)and the control group,with 32 cases in each group.Hemoglobin(Hb)5 plasma D-Dimer(D-D)and Japanese Orthopaedic Association scores(JOA)were compared among the three groups before and after operation.Intraoperative bleeding volume,operation time,operation field quality score and postoperative drainage volume were recorded.Total fluid loss was calculated.Blood loss,intraoperative field,postoperative fibrinolysis and operation effect of TXA were evaluated.Postoperative complications were recorded.【Results】All patients vere followed up for 6 months after surgery.Intraoperative blood loss,postoperative drainage volume,total fluid loss,operation time and Fromme surgical field scores in the combined use group were lower than those in the local use group,while those in the local use group were lower than those in the control group.There was no significant difference in plasma D-D among the three groups before and after operation(P>0.05).The HB value in the combined group was higher than that in the local use group and the control group(P<0.05).The improvement rate of JOA score in the combination group was 72.9%,which was not significantly different from that in the local use group(70.5%)and the control group(69.6%)(P>0.05),The visual field scores of the combined group were significantly lower than those of the local use group and the control group(P<0.05).Two weeks after operation,color Doppler ultrasound examination of both lower limbs was performed in all three groups,and no deep vein thrombosis was found;no pulmonary embolism,cerebrospinal fluid leakage,cerebral infarction,epilepsy and other complications occurred in all three groups.【Conclusion】Intravenous combined local use TXA can reduce overall blood loss hi patients with posterior lumbar surgery,improve intraoperative vision,reduce the operation time,and does not increase the risk of postoperative thrombosis.