氨甲环酸用于腰椎后路减压固定融合术患者的临床研究

Clinical trial of tranexamic acid in posterior decompression and fusion internal fixation for the treatment of lumbar degenerative diseases

目的 探讨氨甲环酸(TXA)对腰椎手术患者术中及术后出血量的影响。方法 回顾性分析腰椎后路减压固定融合术患者的病例信息,根据手术节段数进行1∶1倾向得分匹配,分为对照组和试验组。对照组在手术开始切皮前15 min静脉滴注0.9%NaCl 100 mL;试验组于手术开始切皮前15 min静脉滴注TXA 1 g溶于0.9%NaCl 100 mL。观察2组患者术中出血量和异体血用量,以及术后引流量和血常规。结果 最终试验组和对照组各纳入733例进行统计分析。试验组和对照组的术中出血量分别为240.00和300.00 mL,术后引流量分别为330.00和485.00 mL,术中自体血量分别为120.00和140.00 mL,手术时长分别为140.00和133.00 min,术后血红蛋白分别为119.00和114.00 g·L^(-1),差异均有统计学意义(均P<0.05)。Enter多元线性回归分析显示:节段数、手术时长、术前血红蛋白、术前凝血酶原时间及术前凝血酶时间是独立的影响术中异体血输注的危险因素(均P<0.05);体质量、节段数、TXA、手术时长和术前白细胞数是影响术中出血量的危险因素(均P<0.05);年龄、体质量、节段数、TXA、手术时长、术前纤维蛋白和术前凝血酶时间是影响总引流量的危险因素(均P<0.05)。结论 腰椎手术患者术前应用TXA可有效降低患者术中及术后出血量,但并不增加围术期静脉血栓和肺栓塞的发生率。

Objective To investigate the effectiveness of tranexamic acid(TXA) in intra-operative blood lose and post-operative drainage in patients undergoing posterior lumber decompression and fusion internal fixation operation Methods A retrospective analysis was performed for patients undergoing posterior lumber decompression and fusion internal fixation operation in our hospital. According to the number of intervertebral fusion, 1∶1 propensity score matching was performed. Patients in the control group: 100 mL of 0.9%NaCl was administered intravenously 15 min before the start of the operation. Patients in the treatment group: 1 g of TXA diluted in 100 mL of 0.9%NaCl was administered intravenously 15 min before the start of the operation. The effects of TXA on intra-operative blood lose, allogeneic blood transfusion, post-operative drainage and routine blood examination were assessed. Results Finally, 733 cases were included in the treatment group and control group for statistical analysis. The intra-operative blood losses in treatment and control groups were 240. 00 and 300. 00 mL, post-operative drainage were 330. 00 and485. 00 mL,intra-operative cell saver were 120. 00 and 140. 00 mL,surgery duration were 140. 00 and 133. 00 min,post-operative hemoglobin were 119. 00 and 114. 00 g · L^(-1), the differences were statistically significant( allP< 0. 05). Enter multiple regression analysis showed that number of intervertebral fusion, surgery duration,pre-operative hemoglobin, pre-operative prothrombin time and pre-operative thrombin time were independent riskfactors affecting allogeneic transfusion(allP< 0. 05);weight,number of intervertebral fusion, TXA, surgery durationand pre-operative white blood cell were found to independently predict intra-operative blood loss(allP< 0. 05);similarly, age, weight, number of intervertebral fusion, TXA, surgery duration, pre-operative fibrinogen andpre-operative prothrombin time could independently predict post-operative drainage(allP< 0. 05).Conclusion The application of TXA before operation in patients with posterior lumber decompression and fusion internal fixationoperation can effectively reduce the amount of intra-operative and post-operative blood loss, without increasing theincidence of perioperative venous thrombosis and pulmonary embolism.