静脉滴注氨甲环酸对脊柱经皮椎弓根螺钉手术失血量的影响及安全性

Effect and Safety of Intravenous Tranexamic Acid on Blood Loss in Spinal Percutaneous Pedicle Screw Surgery

目的:探究静脉滴注氨甲环酸对脊柱经皮椎弓根螺钉手术失血量的影响及安全性。方法:选择2018年9月—2021年4月到本院接受治疗的88例胸腰段脊柱创伤患者作为研究对象,根据随机1∶1抽签原则将患者分为氨甲环酸组与对照组,各44例。两组均行脊柱经皮椎弓根螺钉手术治疗,氨甲环酸组在术前与术中给予静脉滴注氨甲环酸,对照组输注等剂量的生理盐水,比较两组出血与输血情况、并发症发生情况、疼痛程度及脊柱功能。结果:氨甲环酸组术中失血量、术中自体输血量、术中异体输血量、术后24h引流量少于对照组(P<0.05);氨甲环酸组并发症发生率为4.5%,低于对照组的25.0%(P<0.05);氨甲环酸组术后1d、3d、7d疼痛视觉模拟量表(VAS)评分低于对照组(P<0.05);氨甲环酸组术后7 d椎体前缘高度高于对照组,Cobb’s角低于对照组(P<0.05)。结论:在脊柱经皮椎弓根螺钉手术中静脉滴注氨甲环酸能改善患者的脊柱功能,缓解疼痛,减少术中失血量与输血量,还可减少并发症的发生概率。

Objective:To investigate the effect and safety of intravenous infusion of tranexamic acid on blood loss in spinal percutaneous pedicle screw surgery.Methods:A total of 88 patients with thoracolumbar spinal trauma who were treated in our hospital from September 2018 to April 2021 were selected as the research subjects.According to the random 1:1 lottery principle,the patients were divided into tranexamic acid group and control group,with 44 cases in each group.Both groups were treated with percutaneous pedicle screw surgery.The tranexamic acid group was given intravenous infusion of tranexamic acid before and during operation,and the control group was given the same dose of normal saline.The bleeding and blood transfusion,complications,pain degree and spinal function were compared between the two groups.Results:The intraoperative blood loss,intraoperative autologous blood transfusion,intraoperative allogeneic blood transfusion,and postoperative 24 h drainage in the tranexamic acid group were less than those in the control group(P<0.05).The incidence of complications in tranexamic acid group was 4.5%,which was lower than 25.0%in control group(P<0.05).The pain visual analogue scale(VAS)score of tranexamic acid group was lower than that of control group at 1 d,3 d and 7 d after operation(P<0.05).The anterior vertebral height of the tranexamic acid group was higher than that of the control group 7 days after operation,and the Cobb's angle was lower than that of the control group(P<0.05).Conclusion:Intravenous infusion of tranexamic acid in percutaneous pedicle screw surgery can improve the spinal function of patients,relieve pain,reduce intraoperative blood loss and blood transfusion,and reduce the incidence of complications.