静脉联合局部应用氨甲环酸对减少腰椎手术失血的有效性及安全性研究

Efficacy and safety of intravenous injection combined with topical application of tranexamic acid in reducing perioperative bleeding of patients with lumbar spine surgery

目的观察静脉联合局部应用氨甲环酸(tranexamic acid,TXA)减少腰椎后路减压内固定融合术围术期失血的有效性及安全性。方法选取腰椎后路减压内固定融合术患者共128例,其中治疗组64例:于术切皮前静脉输注500 mg TXA,术中使用TXA浸湿的方纱局部浸润压迫止血;对照组64例:TXA换成生理盐水,操作同治疗组。观察并比较2组患者一般资料及相关指标变化。结果 2组患者一般资料比较差异均无统计学意义。与对照组相比,治疗组术中出血量、输血量、术后24 h引流量、术后6 h自体血回输量均显著减少(P<0.01)。治疗组患者术后次日晨血红蛋白浓度及术后3日晨血红蛋白浓度、红细胞压积指标明显高于对照组患者(P<0.05)。2组患者凝血酶原时间、纤维蛋白原含量比较差异均无统计学意义。治疗组患者术后住院时间短于对照组(P<0.01)。2组患者术后均无深静脉血栓等并发症发生。结论采用静脉联合局部运用氨甲环酸可明显减少腰椎后路减压内固定融合术术中及术后出血量,缩短患者住院时间,且未增加血栓性疾病的风险。

Objective To explore the efficacy and safety of intravenous injection combined with topical application of TXA in reducing perioperative blood loss in patients with posterior lumbar internal fixation fusion operation. Methods A total of 128 patients undergoing posterior lumbar internal fixation fusion operation were divided into two groups. Treatment group( 64 cases) : 500 mg TXA was intravenously given before operation,and using TXA-soaked gauze to stop bleeding; control group( 64 cases) : TXA was replaced with physiological saline and the patients were given the same process. General information and related indexes were observed and compared between two groups. Results There were no statistical differences of general information between the two groups. The intraoperative bleeding and transfusion,volume of drainage after 12 h surgery,volume of autologous blood transfusion after 6h surgery in treatment group were lower than those in control group( P < 0. 01). The hemoglobin and D-dimer concentrations on the next day morning after surgery,hemoglobin concentration and hematokrit on the third day after surgery in treatment group were higher than those in control group( P < 0. 05). There were no significant differences of prothrombin time and fibrinogen content between two groups. The postoperative length of stay of treatment group was shorter than that of control group( P < 0. 01). There were no complications like deep vein thrombosis occurred in two group.Conclusion Intravenous injection combined with topical application of tranexamic acid in patients with lumbar surgery could significantly reduce tra-and post-operative bleeding and shortern hospital stay without increasing risk of thrombosis.