口服和静脉注射氨甲环酸对于腰椎椎管减压融合术的围手术期失血量影响

Effects of oral and intravenous tranexamic acid on perioperative blood loss after lumbar spinal canal decompression and fusion

目的:探讨氨甲环酸(tranexamic acid,TXA)不同给药方式对腰椎椎管减压融合术围手术期失血量、隐性出血量、输血率,以及不良反应等各方面的影响。方法:对2019年7月至2020年7月接受腰椎椎管减压融合术的60例患者进行回顾性分析,根据TXA不同给药方式分为观察组和对照组,每组30例。观察组术前2 h口服2 g TXA;对照组在切皮前5~10 min予以1 g TXA静脉输注,术后6 h予以1 g TXA静脉输注1次。分别记录两组患者术中出血量、术后引流量、总失血量、隐性失血量、引流管拔除时间、输血率、静脉血栓形成率、不良事件发生率,观察术前和术后1、3 d血红蛋白(hemoglobin,Hb),红细胞比容(hematocrit,HCT)的变化情况。结果:术后1、3 d的Hb及HCT均较术前有明显改善(P<0.01),但组间比较差异无统计学意义(P>0.05)。两组术中出血量、术后引流量、总失血量、术中失血量、隐性失血量、拔管时间、输血率比较差异无统计学意义(P>0.05)。两组患者均未见静脉血栓形成和不良事件发生。结论:在腰椎椎管减压融合术围手术期口服TXA与静脉注射TXA在减少围手术期失血量的效果是相当的,且是安全可靠的,从节约医疗成本和使用便利性方面建议口服TXA。

Objective:To explore the effects of different administration methods of tranexamic acid(TXA)on the perioperative blood loss,hidden blood loss,transfusion rate and adverse reactions in lumbar spinal decompression and fusion.Methods:Sixty patients who received lumbar spinal canal decompression and fusion from July 2019 to July 2020 were enrolled and divided into observation group and control group,with 30 cases in each group.The observation group was given 2 g TXA orally at 2 hours before operation,control group was given 1 g TXA for 5-10 min before skin incision and 6 hours after operation intravenously.The intraoperative blood loss,postoperative drainage,total blood loss,hidden blood loss,drainage tube removal time,blood transfusion rate,venous thrombosis rate,adverse event rate were recorded re spectively.The changes of hemoglobin(Hb)and hematocrit(HCT)were observed before operation and 1,3 days after operation.Results:Hb and HCT at 1 and 3 days after operation were significantly improved compared with those before operation(P<0.01).However,there was no significant difference between the groups(P>0.05).There were no significant difference in amount of blood loss,postoperative drainage,total blood loss,intraoperative blood loss,hidden blood loss,postoperative drainage time,and blood transfusion rate between two groups(P>0.05).There were no venous thrombosis and adverse events occurred in both groups.Conclusion:During the perioperative period of lumbar spinal decompression and fusion,oral TXA and intravenous TXA have the same effect in reducing perioperative blood loss and are safe and reliable.It is recommended that oral TXA be used to save medical costs and convenience.