两种氨甲环酸用药方式对腰椎围术期病人失血量的影响及安全性比较  

TWO WAYS OF MEDICATION OF TRANEXAMIC ACID:A COMPARISON BETWEEN THE TWO METHODS REGARDING PERIOPERATIVE BLOOD LOSS AND SAFETY IN PATIENTS UNDERGOING LUMBAR SURGERY

作　　者：纪强[1] 韩礼纲[1] 巴成磊[1] 

机构地区：[1]青岛大学医学院第二附属医院脊柱外科,山东青岛266042

出　　处：《齐鲁医学杂志》2016年第1期57-60,共4页Medical Journal of Qilu

摘　　要：目的比较氨甲环酸两种用药方式对减少多节段腰椎管狭窄症病人围手术期失血量治疗效果和安全性。方法选择2011年5月—2013年12月于我科行手术治疗的多节段腰椎管狭窄症病人,按照氨甲环酸用药方式分为2组。A组25例,将氨甲环酸2g稀释于9g/L氯化钠溶液100mL中,在手术前30min开始滴注,至手术前15min滴注结束;B组24例,将氨甲环酸1g稀释于9g/L氯化钠溶液100 mL中,在手术前30 min开始滴注,至手术前15min滴注完毕,手术开始后(切皮开始)以10mg/(kg·h)持续滴注直至手术结束。选择同时期未使用氨甲环酸病人24例作为对照组(C组)。对3组病人术中失血量、术后引流量、异体输血例数及手术前后血红蛋白(Hb)和凝血功能等指标进行比较。记录术后药物相关并发症。结果 A、B、C组术中失血量分别为(331.2±203.8)、(410.9±285.0)、(487.5±176.9)mL,术后引流量分别为(341.6±143.9)、(429.8±289.7)、(458.3±76.4)mL,分别有7、8、16例病人行异体输血。A、B组术中失血量、术后引流量及异体输血例数均显著少于C组(F=4.57、9.82,χ2=13.4、14.6,P<0.01),但A、B组间比较差异均无统计学意义(P>0.05)。A、B组均未出现氨甲环酸相关的术后并发症。结论氨甲环酸两种用药方式均能安全有效降低围术期病人的失血量及异体输血率,但术前单剂给药操作更简便,值得临床推广。Objective To compare between the two ways of using tranexamic acid（TXA）on decreasing perioperative blood loss and its safety in patients undergoing surgery for multi-segmental lumbar spinal stenosis（MSLSS）. Methods Patients underwent surgery for MSLSS in our department-between May 2011 and December 2013-were selected,and divided into group A（25cases）and group B（24cases）according to the mode of medication.In group A：2g of TXA was diluted in 100 mL of 9g/L sodium chloride solution,iv drip starting from 30 min before surgery,and ended 15 min before surgery.In group B：1g of TXA was diluted in 100 ml of 9g/L sodium chloride solution,iv drip staring from 30 min before operation and stopped 15 min before surgery.When the operation started,continuous iv drip of TAX was given at the dose of 10mg/（kg·h）until the end of surgery.At the same time,24 patients who did not use TAX were enrolled to serve as the control group（group C）.Blood loss at surgery,postoperative drainage volume,and the number of cases received allogeneic blood transfusion were compared among the three groups.Hemoglobin（Hb）and blood clotting function,before and after surgery,were compared as well.Postoperative drug-related complications were recorded. Results Blood loss at surgery in groups A,B and C was（331.2±203.8）,（410.9±285.0）and（487.5±176.9）mL,respectively.Postoperative drainage volume in the three groups was（341.6±143.9）in group A,（429.8±289.7）mL in group B and 458.3±76.4mL in group C.There were seven patients in group A,eight patients in group B and 16 patients in group C received allogenic blood transfusion.Compared with group C,the blood loss at surgery and postoperative drainage volume in groups A and B were less.No postoperative TAX-related complications were found in groups A and B. Conclusion Both the two ways of using tranexamic acid can effectively reduce blood loss at surgery and the number of allogenic blood transfusion.Preoperative single dose medication is recommended for it easie

关 键 词：氨甲环酸 腰椎 失血 手术 治疗结果 

分 类 号：R681.5[医药卫生—骨科学]