氨甲环酸在腰椎开放手术中血液管理的临床分析

Clinical analysis of tranexamic acid in blood management during open lumbar surgery

目的探讨氨甲环酸在腰椎开放手术中血液管理的临床应用。方法选取本院在2020年1月-2021年10月开展的62例腰椎融合手术进行回顾性分析。对比手术前后出血量、输血量、术后引流量、术中出血量、手术前后HCT和HGB、患者住院时间、拔引流管时间的差异。结果手术出血量、手术中异体输血量、自体血回收、术后住院时间、术后拔管时间无显著性差异(P>0.05)。术后总引流量、理论失血量、术后HGB变化值、术后HCT变化值有显著性差异(P<0.05)。术中使用一次氨甲环酸与术中使用2次氨甲环酸,术后总引流量、理论失血量、术后HGB变化值、术后HCT变化值无显著性差异(P>0.05)。经过统计,研究组病例中无下肢深静脉及肺栓塞发生。结论氨甲环酸术前及术中静脉滴注在腰椎融合手术患者围手术期控制失血量、减少血液丢失、在促进患者加速康复具有非常重要临床意义,并不增加血栓发生的意外风险。

Objective To investigate the clinical application of tranexamic acid in blood management during open lumbar surgery.Methods 62 cases of lumbar fusionsurgery performed in our hospital from January 2020 to October 2021 were analyzed retrospectively.The differences of blood loss before and after operation,blood transfusion volume,postoperative drainage volume,intraoperative blood loss,HCT and HGB before and after operation,hospitalization time of patients and time of extubation were compared.Results There were no significant differences in blood loss,allogeneic blood transfusion volume,autoblood recovery volume,postoperative hospital stay and postoperative extubation time(P>0.05).There were significant differences in postoperative total drainage,theoretical blood loss,changes of HGB and HCT(P<0.05).There were no significant differences in postoperative total drainage,theoretical blood loss,postoperative changes of HGB and HCT,tranexamic acid used once during operation and tranexamic acid used twice during operation(P>0.05).After statistics,there was no deep vein and pulmonary embolism in the study group.Conclusions Intravenous drip of tranexamic acid before and during lumbar fusion surgery has very important clinical significance in controlling blood loss and reducing blood loss,and promoting patients accelerated rehabilitation without increasing the accidental risk of thrombosis.