颈后路单开门椎管扩大成形术围手术期加速康复外科措施中运用氨甲环酸的效果评估

Evaluation of tranexamic acid used in enhanced recovery after surgery for unilateral posterior cervical expansive open-door laminoplasty

背景:加速康复已在颈椎手术中广泛执行,但如何规范使用氨甲环酸以有效减少术中及术后出血,尚缺乏相关研究。目的:评估在颈后路单开门椎管扩大成形术围手术期开展加速康复外科措施时,使用氨甲环酸的有效性、安全性和卫生经济学价值。方法:收集2017年6月至8月,97例接受颈后路C3-C7单开门椎管扩大成形术、围手术期规范应用氨甲环酸的患者纳入观察组。2016年6月至8月,116例接受相同手术、但围手术期未使用氨甲环酸的患者纳入对照组。两组患者均诊断为脊髓型颈椎病。比较两组患者术中出血量、术后第一天引流量、引流管放置时间、总出血量、术后住院时间、术后疼痛VAS评分、术后日常生活能力量表(ADL)评分。结果:两组患者的年龄及性别比例均无显著统计学差异。观察组术中出血平均(225.0±153.9)ml,对照组平均(245.6±198.5)ml,两组比较差异无统计学意义(P>0.05)。观察组术后第一天引流量、引流管放置时间、总出血量、术后住院时间均显著少于对照组[(149.7±72.7)ml vs(172.7±67.1)ml,(1.7±0.8)d vs(3.1±1.0)d,(481.9±226.8)ml vs(562.4±254.2)ml,(2.0±1.2)d vs(3.8±1.7)d,P <0.05]。观察组术后疼痛VAS评分为(1.5±0.5)分,对照组为(1.5±0.6)分,两组间差异无统计学意义(P> 0.05)。观察组术后ADL评分为(75.3±7.3)分,对照组为(77.5±8.5)分,两组间差异也无统计学意义(P> 0.05)。结论:围手术期应用氨甲环酸能够有效减少接受颈后路单开门椎管扩大成形术患者术后的引流量,缩短住院时间,效果显著,应作为颈椎后路手术围手术期加速康复外科措施的重要环节之一。

Background:The measures of enhanced recovery has been widely used in cervical operation.But there are few reports of the standardized use of tranexamic acid to reduce intraoperative and postoperative bleeding.Objective:To study the effectiveness,safety and health economic value of tranexamic acid used in enhanced recovery after surgery(ERAS)in patients undergoing unilateral posterior cervical expansive open-door laminoplasty.Methods:We performed a retrospective analysis in a total of 213 patients who underwent unilateral posterior C3-C7 open-door expansive laminoplasty.Tranexamic acid was used in 97 patients during perioperative period between June and August 2017(observation group)and was not used in 116 patients between June and August 2016(control group).Intraoperative blood loss,drainage amount in the first postoperative day,placement time of drainage tube,total bleeding volume,postoperative hospital stay,visual analogue scale(VAS)score and postoperative activities of daily living(ADL)score were compared between the two groups.Results:There was no significant difference in the age or sex ratio between the two groups.The mean intraoperative hemorrhage amount was(225.0±153.9)ml in the observation group and(245.6±198.5)ml in the control group(P>0.05).However,compared with those in control group,hemorrhage amount measured in the first postoperative day,placement duration of drainage tube,total bleeding volume,and postoperative hospital stay were significantly decreased in observation group([149.7±72.7]ml vs[172.7±67.1]ml,[1.7±0.8]d vs[3.1±1.0]d,(481.9±226.8)ml vs(562.4±254.2)ml,[2.0±1.2]d vs[3.8±1.7]d,P<0.05).No significant difference was found in postoperative VAS score(1.5±0.5 vs 1.5±0.6)or ADL score(75.3±7.3 vs 77.5±8.5)between observation group and control group(P>0.05).Conclusions:Perioperative tranexamic acid can significantly reduce postoperative drainage amount and shorten the duration of hospital stay in patients undergoing unilateral posterior cervical expansive open-door laminoplasty.It should be taken as a vital part of ERAS in cervical posterior surgery.