腰椎管狭窄症行后路短节段融合术围术期阿司匹林使用的病例对照研究

Perioperative use of aspirin in surgical treatment of lumbar spinal stenosis with posterior short-segment fusion:a case-control study

目的对伴有血管意外风险的腰椎管狭窄症患者行后路短节段融合围术期持续应用阿司匹林进行探索。方法收集我科2018年9月至2021年12月诊断为腰椎管狭窄症,伴有血管意外风险,并行不超过3个节段融合术的92例患者的临床资料。根据围术期是否停用阿司匹林分为阿司匹林组(围术期继续服用阿司匹林,n=46)和对照组(围术期停用阿司匹林,n=46)。比较分析两组患者的基本信息、术中失血量、输血率、并发症和随访结果,并进行统计学比较。结果两组在一般资料和手术相关数据上差异无统计学意义。阿司匹林组平均术中失血量(302.3±121.7)ml多于对照组(253.6±126.4)ml,但差异无统计学意义(P=0.603)。两组术后总失血量差异无统计学意义[(156.9±89.8)ml vs.对照组(130.5±74.6)ml,P=0.128]。阿司匹林组术后第2天引流液红细胞压积(hematocrit,Hct)为(13.9±4.1)%,明显高于对照组的(10.1±5.7)%(P=0.31)。阿司匹林组术后第2天失血量(35.7±22.2)ml显著高于对照组的(21.0±18.3)ml,差异有统计学意义(P=0.010)。两组围术期异体输血率均为0。两组所有患者住院期间及术后3个月内均未发生血管意外、切口感染及椎管内血肿形成。阿司匹林组所有患者均未发生阿司匹林相关的药物不良反应。结论3个节段以内的腰椎后路融合围术期不停用阿司匹林不会增加术中失血量、输血率及引流管放置时间。建议伴有血管意外风险的患者行此类手术围术期继续使用阿司匹林。

Objective To investigate the continuous use of aspirin in surgical treatment of lumbar spinal stenosis with posterior short segment fusions among patients with risks of vascular events.Methods Data of 92 patients diagnosed as lumbar spinal stenosis with risks of vascular accidents were collected from September 2018 to December 2021 in our center.All were treated with no more than 3 segmental fusions.Patients were divided into the aspirin group(perioperative use of aspirin,n=46)and control group(no perioperative use of aspirin,n=46).The basic information,intraoperative blood loss,blood transfusion rate,complications and follow-up results of the two groups were compared and analyzed.Results There were no significant differences in population and surgical data between the two groups.The mean intraoperative blood loss of the aspirin group(302.3±121.7)ml was higher than that of control group(253.6±126.4)ml,but the differences were not statistically significant(P=0.603).There were no significant differences in total blood loss between the two groups[(156.9±89.8)ml in the aspirin group,(130.5±74.6)ml in the control group](P=0.128).The Hct of drainage fluid in the aspirin group was(13.9±4.1)%on the second day after operation,which was significantly higher than that in the control group(10.1±5.7)%(P=0.31).The blood loss on day 2 after operation in the aspirin group(35.7±22.2)ml was significantly higher than that in the control group(21.0±18.3)ml(P=0.010).No patients in both groups required allogeneic blood transfusion perioperatively.No vascular accident,incision infection or intraspinal hematoma occurred during hospitalization and 3 months after operation in both groups.No aspirin-related adverse drug reactions occurred in the aspirin group.Conclusions Continuous use of aspirin in posterior lumbar surgeries with fusion of no more than 3 levels does not increase perioperative blood loss,transfusion rate or drainage tube placement.It is recommended for patients with risks of vascular events.