脊柱结核病灶清除术中局部应用凝血酶冻干粉的疗效分析

Analysis of therapeutic effect of local application of thrombin lyophilized powder in the eradication of spinal tuberculosis focus

目的探索脊柱结核病灶清除术中局部应用凝血酶冻干粉的疗效。方法回顾性分析2020年1—9月首都医科大学附属北京胸科医院收治的脊柱结核行后路病灶清除植骨内固定的106例手术患者,按照术中有无局部使用凝血酶冻干粉分为两组。观察组(52例)接受术中局部使用凝血酶冻干粉进行止血;对照组(54例)未局部使用凝血酶冻干粉。比较两组患者术中失血量、术后24h内失血量、术后总引流量、最大血红蛋白下降值、术后1周的红细胞比容(HCT)、输血率、围手术期的并发症(血栓事件、切口不愈合、切口感染、皮下积血、尿路感染、肺部感染等)发生情况、引流管拔除时间。结果观察组的术后24h引流量、术后总引流量、拔除引流管的时间、术后HCT、术后血红蛋白最大下降值分别为(182.8±54.6)ml、(450.4±119.2)ml、(5.5±1.5)d、(30.4±5.6)%、(35.8±12.5)g/L,均低于对照组[分别为(358.4±45.1)ml、(646.3±87.9)ml、(7.2±2.1)d、(27.2±7.3)%、(48.3±17.9)g/L],差异均有统计学意义(t=2.732,P=0.009;t=2.264,P=0.037;t=2.132,P=0.048;t=2.238,P=0.049;t=2.056,P=0.043)。术后输血率分别为19.2%(10/52)与27.8%(15/54),差异无统计学意义(χ^(2)=1.074,P=0.300)。两组患者术后均未出现相关并发症。结论凝血酶冻干粉能进一步减少脊柱结核手术的总失血量、24h内的失血量、血红蛋白下降值,且不增加术后并发症的发生风险,能有效起到快速康复的目的。

Objective To explore the therapeutic effect of local application of thrombin lyophilized powder in the eradication of spinal tuberculosis focus.Methods A total of 106 spinal tuberculosis patients treated with parallel eradication of posterior spinal tuberculosis and internal fixation of bone graft between January 2020 and September 2020 from Beijing Chest Hospital Affiliated to Capital Medical University were retrospectively analyzed.They were divided into 2 groups according to the local use of thrombin during operation.The observation group(n=52)was treated with local use of thrombin for hemostasis,and the control group(n=54)was not treated with local use of thrombin.The intraoperative blood loss,24 h postoperative blood loss,total postoperative flow,the maximum hemoglobin decrease,the percentage of hematocrit(HCT)one week after operation,the rate of blood transfusion,the occurrence of perioperative complications(thrombosis,incision nonunion,incision infection,subcutaneous hemorrhage,urinary tract infections,pulmonary infection,etc.),and the time of drainage tube removal of the two groups were compared.Results The postoperative flow 24 h postoperative,the total postoperative flow,the remove time of drainage tube,the HCT after the operation,the maximum hemoglobin decrease after the operation of observed group were significantly lower than those of the control group((182.8±54.6)ml vs.(358.4±45.1)ml,t=2.732,P=0.009;(450.4±119.2)ml vs.(646.3±87.9)ml,t=2.264,P=0.037;(5.5±1.5)d vs.(7.2±2.1)d,t=2.132,P=0.048;(30.4±5.6)%vs.(27.2±7.3)%,t=2.238,P=0.049;(35.8±12.5)g/L vs.(48.3±17.9)g/L,t=2.056,P=0.043;respectively).The postoperative transfusion rates were 19.2%(10/52)and 27.8%(15/54)respectively in the two groups,and the difference was not significant.Conclusion Thrombin lyophilized powder can further reduce the total blood loss,the blood loss and the decreased value of hemoglobin within 24 h after the surgery of spinal tuberculosis,without increasement of the risk of postoperative complications,and can effectively promote the recovery.