腰椎手术失血动物模型的建立及相关研究

Setup of lumbar surgery model for animals with blood loss and related researches

目的 研究分析应用氨甲环酸对早期围手术期失血腰椎手术兔模型与腰椎管狭窄症(lumbar spinal stenosis, LSS)行手术治疗患者的影响。方法 选取成年兔20只建立动物兔脊柱手术模型后进行分组,平均分为实验组(采用氨甲环酸)与对照组(不采用氨甲环酸),所有实验兔于术前24 h及术后24 h、72 h分别采集耳缘静脉血进行血常规检查,并记录术中出血量和手术时间。选取120例LSS手术治疗的患者行回顾性分析,基于氨甲环酸使用情况分为10、30、50 mg组,对比3组一般资料、手术失血情况及手术前后血液指标情况。结果 动物模型方面,两组术前相关数据差异无统计学意义(t=-1.606、-0.105,P=0.126、0.917),术中失血量和手术时间差异均有统计学意义(t=13.702、10.512,P<0.01),术后24 h血红蛋白含量差异有统计学意义(t=-7.427,P<0.01),实验组明显优于对照组。LSS患者方面,术中出血量、术后引流量、总失血量及围术期输血量对照组>10 mg组>30 mg组>50 mg组,两两比较差异均有统计学意义(F=24.156、15.562、30.261、41.125,P<0.01),其余无明显差异。结论 术前使用氨甲环酸可明显减少术中失血量、缩短手术时间,对其他原因引起的隐性失血无明显作用。对LSS行手术治疗的患者,术前使用大剂量氨甲环酸可减少术中失血量,降低围手术期血栓风险。

Objective To study the effects of tranexamic acid on early perioperative blood loss, lumbar vertebrae rabbit model and lumbar spinal stenosis(LSS) surgery for patients.Methods Twenty adult rabbits were subject to grouping after being selected, and the rabbits were equally divided into the experimental group(with tranexamic acid) and the control group(without tranexamic acid).All tested rabbits were collected 24 hours before operation and 24 and 72 hours after operation for blood routine examinations, and intraoperative blood loss, operation duration of lower extremities.One hundred and twenty patients receiving LSS surgical treatment were selected for retrospective analysis, and the patients were divided into the 10 mg group, 30 mg group, 50 mg group based on administration conditions of tranexamic acid, and the general data, surgical blood loss and blood indicators before and after surgeries in 3 groups were compared.Results The difference in preoperative data in two groups in terms of the animal model wasn′t statistically significant(t=-1.606,-0.105,P=0.126,0.917),and the differences in both intraoperative blood loss and surgical duration were statistically significant(t=13.702,10.512,P<0.01),the differences in postoperative 24 hours hemoglobin content were statistically significant(t=-7.427,P<0.01),and the results in the experimental group were significantly better than those in the control group.The intraoperative blood loss, postoperative drainage, total blood loss and perioperative transfusion volume were found to be true for the control group>10 mg group>30 mg group>50 mg group for LSS patients, and the differences in pairwise comparisons were statistically significant(F=24.156,15.562,30.261,41.125,P<0.01),and the differences in remaining indicators weren′t statistically significant.Conclusion Preoperative application of tranexamic acid can significantly decrease the intraoperative blood loss, shorten the surgical duration without significant effects on hidden blood loss resulting from other reasons.Preoperative use of large-dose tranexamic acid on patients with LSS surgery can reduce intraoperative blood loss of patient, and reduce the risk of perioperative thrombosis.