氨甲环酸联合利伐沙班对后路腰椎椎间融合术围手术期失血的影响及益处

Effect of tranexamic acid combined with rivaroxaban on perioperative blood loss in patients undergoing posterior lumbar interbody fusion and its benefits

目的探讨氨甲环酸联合利伐沙班对后入路腰椎椎间融合术围手术期失血量的影响及其益处。方法采用回顾性研究,收集济宁医学院附属医院2019年9月至2021年9月因腰椎管狭窄症或腰椎滑脱症行后入路腰椎椎间融合术的患者90例的临床资料,根据患者用药情况分为A组46例、B组44例。A组患者于手术切皮前15 min静脉滴注氨甲环酸0.5 g+5%葡萄糖注射液100 mL,并在手术关闭切口前外用氨甲环酸溶液1 g浸泡切口创面5 min,并在切口闭合前抽吸;B组患者操作同A组,但于术后口服利伐沙班,每天1次,每次10 mg,至术后35 d。观察两组手术时间、术中失血量和引流量,并计算总失血量和隐性失血量,以及下肢深静脉血栓形成、肺栓塞发生、硬膜外血肿形成情况和C反应蛋白水平。结果两组手术时间、术中失血量、引流量、总失血量和隐性失血量差异均无统计学意义(均P>0.05);A组术后C反应蛋白[29.94(15.75,50.25)mg/L]高于B组[7.89(4.94,11.10)mg/L],差异有统计学意义(Z=-5.68,P<0.05)。两组患者术后均无下肢深静脉血栓、肺栓塞、硬膜外血肿发生。A组术后1例输注去白悬浮红细胞200 mL,1例患者输注自体血150 mL;B组患者术后2例输注去白悬浮红细胞,分别为525 mL、200 mL,其余患者均未输血。结论氨甲环酸联合利伐沙班用于后入路腰椎椎间融合术中不会增加围手术期的出血量,并有额外的抗炎作用,且不增加下肢深静脉血栓形成、肺栓塞发生率,不增加硬膜外血肿的形成和输血率。

Objective To investigate the effect of tranexamic acid combined with rivaroxaban on perioperative blood loss in patients undergoing posterior lumbar interbody fusion and its potential benefits.Methods This is a retrospective study.The clinical data of 90 patients who underwent posterior lumbar interbody fusion for lumbar spinal stenosis or spondylolisthesis at Affiliated Hospital of Jining Medical University between September 2019 and September 2021 were analyzed.These patients were divided into two groups:group A(n=46)and group B(n=44)based on their medication.Patients in group A received an intravenous infusion of 0.5 g tranexamic acid and 100 mL of 5%glucose injection 15 minutes before the surgical incision.The incision wound was soaked externally with 1 g of tranexamic acid solution for 5 minutes before the surgical incision was closed,and it was suctioned before its closure.Patients in group B received the same procedure,except that oral rivaroxaban was administered 10 mg,once daily,after surgery till 35 days after surgery.The operative time,intraoperative blood loss,and the amount of drainage were recorded.Total blood loss,occult blood loss,incidence of lower extremity deep vein thrombosis,incidence of pulmonary embolism and epidural hematoma,and C-reactive protein levels were determined.Results There were no significant differences in operative time,intraoperative blood loss,the amount of drainage,total blood loss,and occult blood loss between the two groups(all P>0.05).Postoperative C-reactive protein levels in group A[29.94(15.75,50.25)mg/L]were significantly higher than those in group B[7.89(4.94,11.10)mg/L,Z=-5.68;P<0.05].Lower extremity deep vein thrombosis,pulmonary embolism,or epidural hematoma did not occur in either group.In group A,one patient was infused with 200 mL of leucodepleted red blood cell suspension,while the other patient received 150 mL of autologous blood transfusion.In group B,two patients were infused with 525 mL and 200 mL of leucodepleted red blood cell suspensions,respectively,while the rest did not require blood transfusion.Conclusion The combined use of tranexamic acid and rivaroxaban after posterior lumbar interbody fusion does not increase perioperative bleeding,and it has additional anti-inflammatory effects without increasing the incidence of lower extremity deep vein thrombosis and pulmonary embolism,as well as the formation of epidural hematomas and the need for blood transfusion.