静脉注射不同剂量氨甲环酸对短节段腰椎管狭窄症患者术后失血的研究

Study of postoperative blood loss on patients with short segmental lumbar spinal stenosis with different doses intravenous tranexamic acid

目的对比研究静脉注射不同剂量氨甲环酸对短节段腰椎管狭窄症患者术后失血的影响,并初步评估其安全性。方法选取2013年3月至2015年3月在我院就诊为短节段(1~2节段)腰椎管狭窄症的患者123例,应用随机数字表法随机分为术前静脉滴注10 mg/kg氨甲环酸(TXA)的低浓度组(L组,n=41)、术前静脉滴注15 mg/kg TXA的高浓度组(H组,n=41)及术前静脉滴注生理盐水的对照组(C组,n=41),记录一般资料、术前血液学指标、术中出血量、术后引流量、隐性出血量、总失血量、输血率及术后深静脉血栓率,采用单因素方差分析及LSD检验统计计量资料,采用多个独立样本的非参数检验(K检验)分析计数资料。结果三组患者一般资料差异无统计学意义(P>0.05);术中出血量H组少于C组及L组(P=0.001,P=0.045),C组与L组之间差异无统计学意义(P=0.079);术后引流量,H组引流量最少(P=0.000,P=0.000),L组较C组引流量少(P=0.000);三组患者术前血红蛋白量之间差异无统计学意义(F=0.034,P=0.967);术后第1天,H组血红蛋白含量较C组及L组高(P=0.001,P=0.009);术后第4天,H组血红蛋白含量最高(P=0.000,P=0.019);H组术后总失血量最少(P=0.000,P=0.022)、显性失血量最少(P=0.000,P=0.000)及隐性失血量最少(P=0.001,P=0.045);L组较C组少(P=0.005,P=0.000,P=0.028);术后三组第1、7天深静脉血栓发生率之间差异无统计学意义(F=1.008,P=0.604,F=2.033,P=0.362);术后输血率三组之间差异有统计学意义(F=6.467,P=0.039),其中H组为9.8%,L组为19.5%,C组为34.1%。结论静脉注射TXA可以减少短节段椎管狭窄症患者术后隐性出血量及总失血量,应用15 mg/kg剂量TXA效果更为明显,而增加剂量并不会增加术后双下肢深静脉血栓的风险。

Objective To study the effect of postoperative blood loss on short segmental lumbar spinal stenosis with different doses intravenous tranexamic acid and to evaluate its safety.Methods We enrolled 123 patients who were in need of posterior lumbar interbody fusion surgery of 1 to 2 segments owing to degenerative spinal stenosis between March 2013 and March 2015 in our hospital,according to random number table were divided into low concentration group with intravenous infusion of 10 mg/kg TXA preoperatively(L group,n=41) and high concentration group with intravenous infusion of 15 mg/kg TXA preoperatively(H group,n=41) and control group with intravenous injection of saline preoperatively(group C,n=41).The general information,preoperative blood routine indexes,intraoperative bleeding volume,postoperative draining volume,hidden blood loss,total blood loss,blood transfusion rate and postoperative deep vein thrombosis rate were detected.For statistical analysis,the quantitative variables were compared using one-way analysis of variance and least significant difference(LSD) test,and the enumeration variables were calculated by K independent samples test.Results There was not statistically different with general information amoung three groups(P>0.05).The volume of intraoperative blood loss of group H was less than group C and group L(P=0.001,P=0.045),while there was no significant difference between the group C and the group L(P=0.079).Compared to group L and group C,the group H had the minimum volume of postoperative drained blood(P=0.000,P=0.000),and there had difference between the group C and group L(P=0.000).Three groups had no difference with hemoglobin content(F=0.034,P=0.967),while the group H had maximum hemoglobin contenton on the first day after operation(P=0.001,P=0.009)and it was greatest hemoglobin content in the group H among three groups on postoperative 4(P=0.000,P=0.019).Compared with the group L and group C,group H had minimum volume of total blood loss(P=0.000,P=0.022),drained blood loss(P=0.000,P=0.000),hidden blood loss(P=0.001,P=0.045),and group L was lower compared with group L(P=0.005,P=0.000,P=0.028).No significant differences were observed in the incidence of postoperative deep vein thrombosis among three groups on postoperative 1,7(χ~2=1.008,P=0.604,χ~2=2.033,P=0.362).The postoperative blood transfusion rate was statistically difference among three groups(χ~2=6.467,P=0.039),of which group H was 9.8%,group L was 19.5%and group C was 34.1%.Conclusions Intravenous TXA can reduce the volume of hidden blood loss and total blood loss of which patients with short segmental spinal canal stenosis,an dose of 15 mg/kg TXA was better,which did not increase the the risk of postoperative venous thrombosis.