氨甲环酸多次静脉给药在后入路腰椎内固定融合术中对炎症和凝血-纤溶系统的作用

Effects of repeated intravenous administration of tranexamic acid on inflammation and the coagulation-fibrinolytic system of patients with posterior lumbar spinal instrumentation fusion

目的 探究氨甲环酸(TXA)多次静脉给药在后入路腰椎内固定融合术中对炎症和凝血-纤溶系统的影响。方法 分析2019年3月—2021年6月徐州医科大学附属医院收治的90例行腰椎内固定融合手术的患者,分为对照组、单次给药组和多次给药组,每组30例。对照组切皮前30 min静脉输入生理盐水250 mL一次;单次给药组手术切皮前30 min静脉输入TXA 15 mg/kg一次;多次给药组切皮前30 min静脉使用TXA 15 mg/kg,切皮后3、6和9 h再分别追加使用TXA 15 mg/kg一次。分析患者术前、术后1、3和7 d炎症指标[白细胞计数(WBC)、C反应蛋白(CRP)和IL-6]和凝血-纤溶指标[D-二聚体(DD)、纤维蛋白原降解产物(FDP)、活化部分凝血活酶时间(APTT)和凝血酶原时间(PT)]变化,以及手术时间、围手术期总失血量、隐性失血量和术后48 h引流量、自体血回输量、异体血红细胞输入量、术后血红蛋白水平。结果 单次与多次给药组术后1、3 d WBC、CRP和IL-6水平低于对照组(P<0.05),且多次给药组WBC、CRP、IL-6水平低于单次给药组(P<0.05);术后7 d时3组患者WBC水平比较差异无统计学意义(P>0.05),单次与多次给药组CRP、IL-6水平低于对照组(P<0.05),单次与多次给药组CRP、IL-6水平比较差异无统计学意义(P>0.05)。单次与多次给药组术后1、3 d DD和FDP水平都低于对照组(P<0.05),单次与多次给药组DD和FDP比较差异无统计学意义(P>0.05);术后7 d时3组患者DD和FDP水平比较差异无统计学意义(P>0.05)。3组患者术后1、3、7 d APTT和PT水平比较差异无统计学意义(P>0.05)。单次与多次给药组术中出血量均少于对照组(P<0.05),多次给药组隐性出血量和术后引流量均少于单次给药组(P<0.05)。单次与多次给药组手术时间和异体血红细胞输入量均少于对照组(P<0.05),单次和多次给药组手术时间和异体血红细胞比较差异无统计学意义(P>0.05)。多次给药组自体血回输量小于对照组和单次给药组(P<0.05)。3组患者术后1、3、7 d血红蛋白水平比较差异无统计学意义(P>0.05)。结论 腰椎内固定融合术中多次静脉使用TXA可以进一步减少患者术后炎症反应,同时减少纤溶因子的释放,但对凝血功能无明显影响。

Objective To investigate the effects of repeated intravenous administration of tranexamic acid(TXA)on inflammation and the coagulation-fibrinolytic system of patients with posterior lumbar spinal instrumentation fusion.Methods A total of 90 patients who underwent lumbar internal fixation and fusion surgery from March 2019 to June 2021 were divided into a control group,a single-dose group,and a multiple-dose group.Inflammatory markers(WBC,CRP,and IL-6)and coagulation-fibrinolytic markers(D-dimer,fibrinogen degradation product(FDP))were measured before and at 1,3,and 7 days postoperatively.Activated partial thrombin time(APTT)and prothrombin time(PT),perioperative total blood loss,latent blood loss,and postoperative drainage at 48h.Results WBC,CRP,and IL-6 in the multiple-dose group and the single-dose group were lower than those in the control group 1 and 3 days post-operative(P<0.05),and inflammatory markers in the multiple-dose group were lower than those in the single-dose group(P<0.05).DD and FDP in the multiple-dose group and the single-dose group were lower than those in the control group 1 and 3 days post-operative(P<0.05),and there was no significant difference between the two groups(P>0.05).No significant difference was found in APTT and PT levels among the three groups(P>0.05).The intraoperative blood loss in the multiple-dose group and single-dose group was less than that in the control group(P<0.05),and the recessive blood loss and postoperative drainage in the multiple-dose group were less than that in the single-dose group(P<0.05).Conclusion Repeated intravenous use of TXA in lumbar internal fixation fusion can further reduce the inflammatory response and fibrinolytic factor release,but it does not affect coagulation function.