切口内应用氨甲环酸对腰椎后路椎间融合术后失血的影响  

The safety and efficacy of local administration of tranexamic acid into posterior lumbar interbody fusion wounds

作　　者：卜国云[1] 吴叶[2] 邓树才[1] 杜区成 朱加亮[2] 崔成亮[2] 侯树勋[2] 

机构地区：[1]天津市天津医院脊柱I科,300211 [2]解放军总医院第一附属医院骨二科,北京100048

出　　处：《中国矫形外科杂志》2014年第18期1637-1641,共5页Orthopedic Journal of China

基　　金：全军十二五面上项目(编号:CWS11J100)

摘　　要：[目的]探讨腰椎手术切口内应用氨甲环酸对术后失血的影响及其应用的安全性。[方法]对2012年6月-2013年6月间初次行腰椎单节段或双节段腰椎后路椎间融合术的267例患者进行前瞻性研究,将患者随机分为实验组（A组）和对照组（B组）。在手术缝合深筋膜后向A组患者切口内注射氨甲环酸10 ml（1 g）,B组向切口内注射生理盐水10 ml作为对照,并夹闭引流管1 h。比较两组患者一般资料、术前血液学指标、术中失血量及输血量、术后引流时间、第一个24 h引流量及总引流量、术后血D-二聚体浓度、术后输血例数及输血量。分别比较A、B两组中单、双节段术后引流量。术后1周及术后3个月随访时检查双下肢血管超声,观察有无深静脉血栓形成。[结果]A组患者133例,B组患者134例。术前A、B组性别、年龄、体重指数、平均血红蛋白浓度、凝血酶原时间比较无明显统计学差异;术中失血及输血量两组间无明显统计学差异;术后拔管时蛋白浓度A组为（113.6±13.0）g/L,B组为（105.1±14.4）g/L,两组间有显著统计学差异。术后平均拔管时间A组为（2.1±0.4）d,B组为（2.8±0.8）d,两组间有统计学差异;术后平均引流总量A组患者为（272±124）ml,B组患者为（412±189）ml,两组间有统计学差异;A组术后输血5例,B组术后输血15例,两组间具有统计学差异。术后A组患者平均输血（400±100）ml;B组患者平均输血（503±179）ml,两组患者术后输血量无明显统计学差异。术后1周及3个月随访时两组患者均未发现有下肢深静脉血栓形成。[结论]腰椎后路椎间融合术切口内局部应用氨甲环酸可减少术后伤口失血量、缩短拔管时间、不增加局部血肿压迫神经和深静脉血栓形成的风险,减少了术后失血。[Objective] To explore the safety and effectiveness of local administration of tranexamic acid into posterior lumbar interbody fusion（ PLIF） wounds.[Method]Two hundred and sixty- seven patients who underwent PLIF of one or two segments for the first time from January 2013 to June 2013 were included in this prospective study. The patients were divided into an experimental group（ group A） and control group（ group B）. Tranexamic acid（ 10 ml） was injected into the PLIF wounds after the deep fascia was closed in group A,and saline（ 10 ml） was injected into the PLIF wounds of group B. The drain pipes were clamped for 1 h. The hematologic data,volume of blood loss and intraoperative transfusion,duration of drainage,volume of the first 24- h drainage and general drainage,postoperative D- dimer level,number of patients receiving blood transfusions,and the volume of blood transfusion were compared between the two groups. The volume of drainage in the single and double segments and the different number of windows were compared between the groups. Vascular ultrasonography was performed on the patients＇ lower extremities to detect deep venous thrombosis at 1 week and 3 months postoperatively. [Result]There were 133 patients in group A and 134 patients in group B. There were no statistical differences in sex,age,body mass index,and mean hemoglobin level and prothrombin time preoperatively between the two groups,and the same results to volume of blood loss and transfusions intraoperatively. The mean hemoglobin level was 113. 6 ± 13. 0 g /L in group A and 105. 1 ± 14. 4 g /L in group B at the time of extubation,and there was a statistically significant difference. There was a statistically significant difference in time of extubation between the two groups with 2. 1 ± 0. 4 days for group A and 2. 8 ± 0. 8 days for group B. The volume of general drainage was 272 ± 124 ml in group A and 412 ± 189 ml in group B,which was statistically significant. Five patients in group A and 15 patients in group B recei

关 键 词：氨甲环酸 腰椎后路椎间融合术 引流量 术后失血 

分 类 号：R687.3[医药卫生—骨科学]