氨甲环酸不同静脉给药方式对青少年特发性脊柱侧凸后路矫形术中出血量的影响

Effect of different intravenous administration of tranexamic acid on intraoperative blood loss in posterior orthopaedic surgery for adolescent idiopathic scoliosis

目的对比氨甲环酸(TXA)不同静脉给药方式对青少年特发性脊柱侧凸(AIS)后路矫形术中出血量的影响及安全性。方法2017年1月-2020年3月,廊坊市第四人民医院采用脊柱后路矫形术治疗AIS患者120例,按照随机数字表法分为3组,每组40例。A组切开皮肤前15 min静脉滴注TXA 30 mg/kg;B组切开皮肤前15 min静脉滴注TXA 15 mg/kg,术中给予TXA 10 mg/(kg·h)维持至术毕;C组围手术期不使用TXA。比较3组手术时间、术中出血量、异体血输注量、晶体输注量、胶体输注量、术后输血率、术后引流量及手术前后血红蛋白(Hb)水平、D-二聚体(D-D)水平等指标,并记录并发症发生情况。结果所有手术顺利完成。A、B组术中出血量、异体血输注量、胶体输注量、术后输血率、术后1 d引流量低于C组,术后各时间点Hb水平高于C组,差异均有统计学意义(P<0.05);以上指标A、B组组间比较,差异无统计学意义(P>0.05)。3组术后各时间点D-D水平均较术前明显升高,术后1 d达到最高值,之后逐渐下降;术后各时间点A、B组D-D水平低于C组,差异均有统计学意义(P<0.05);A、B组组间比较,差异无统计学意义(P>0.05)。所有患者切口愈合良好,术后双下肢血管超声检查未见深静脉血栓形成。术后电话随访均未出现相关并发症。结论术前TXA足够剂量静脉滴注可取得与首次负荷量联合术中维持量静脉滴注相同的止血效果,无安全隐患,术前单剂量静脉滴注在操作上更为简便,值得推广应用。

Objective To compare the efficacy and safety between different intravenous administration methods of tranexamic acid(TXA)in reducing blood loss during posterior orthopaedic surgery in adolescent idiopathic scoliosis(AIS)patients.Methods Clinical data of 120 patients with AIS who underwent posterior spinal orthopaedic surgery in the Fourth People's Hospital of Langfang from January 2017 to March 2020 were retrospectively analyzed.They were divided into 3 groups according to random number table method,with 40 cases in each group.Group A were given TXA 30 mg/kg intravenously 15 min before skin incision;group B were given TXA 15 mg/kg intravenously 15 min before skin incision,and TXA 10 mg/(kg·h)was given intraoperatively until the end of surgery;group C were not given TXA during perioperative period.The operation time,intraoperative blood loss,allogeneic blood transfusion,crystalloid infusion,colloid infusion,postoperative blood transfusion rate,postoperative drainage volume,and the level of hemoglobin(Hb)and D-dimer(D-D)before and after surgery were compared between the 3 groups,and the incidence of complications were recorded.Results All the operations were completed successfully.The intraoperative blood loss,allogeneic blood transfusion,colloid infusion,postoperative blood transfusion rate and postoperative drainage volume at postoperative 1 d in groups A and B were lower than those in group C,and the Hb level in groups A and B were higher than that of group C at all time point,and the differences were statistically significant(P<0.05).There was no statistical significance in the difference of above indexes between group A and B(P>0.05).D-D level in the 3 groups was significantly higher than that before surgery at all time points,and reached the highest value on the first day after surgery,and then decreased gradually;the D-D level in groups A and B was lower than that in group C at all time points after operation,with a statistical significance(P<0.05);and there was no significant difference between group A and group B(P>0.05).The incision healing was good in all the patients,and no deep vein thrombosis was found in the postoperative vascular ultrasound examination of lower limbs.Postoperative telephone follow-up showed no complications.Conclusions Preoperative adequate dose of TXA intravenous infusion can achieve the same hemostasis effect as the initial load combined with intraoperative maintenance dose intravenous infusion.Preoperative single-dose intravenous infusion is simpler in operation and worthy of wider clincal application.