氨甲环酸的局部应用对减少腰椎后路融合术术后出血量效果及安全性研究  

Effect and safety of local medication of tranexamic acid on reducing postoperation blood loss in posterior lumbar fusion

作　　者：徐飞 杨丕斌[1] 刘思波[1] 甄涛 何忠宝[1] 李宏键[1] XU Fei;YANG Pibin;LIU Sibo;ZHEN Tao;HE Zhongbao;LI Hongjian(Department of Orthopedics,the First people′s Hospital of Yunnan Province,Kunming,Yunnan 650034,China)

机构地区：[1]云南省第一人民医院骨科,云南昆明650032

出　　处：《岭南现代临床外科》2018年第2期215-217,221,共4页Lingnan Modern Clinics in Surgery

基　　金：地区科学基金项目(F010810;F010805)

摘　　要：目的评估氨甲环酸切口内局部应用对减少腰椎后路融合术术后出血量的有效性及安全性。方法回顾2015年1月~2017年2月81例因退行性腰椎管狭窄初次行腰椎后路单节段及双节段融合手术的患者。根据术中是否使用氨甲环酸分为氨甲环酸组(A组)39例,对照组(B组)42例,所有患者均行腰椎后路椎弓根螺钉固定、椎间盘切除植骨融合术,A组术毕后切口内注射氨甲环酸注射液(100 m L:1 g),B组不使用,术后夹闭引流管2 h。比较术后24小时及总引流量,观察下肢深静脉血栓形成、肺栓塞发病率。结果两组在年龄、性别、腰椎融合节段数、术前血液学、手术时间以及术中失血量无统计学差异(P>0.05),但是A组术后引流量明显低于B组,结果具有统计学意义(P<0.05)。两组均无并发下肢深静脉血栓形成及肺栓塞的病例。结论术毕切口局部应用氨甲环酸可显著减少腰椎后路融合术后失血量,且不增加肺栓塞及下肢深静脉血栓形成的风险。Objective To investigate the effect and safety of local medication of tranexamic acid into wounds on reducing postoperation blood loss in posterior lumbar fusion for degenerative lumbar stenosis.Methods A retrospective study from January 2015 to February 2017 were performed for 81 patients with degenerative lumbar stenosis who first underwent posterior lumbar fusion surgery of one or two segments.The patients were divided into tranexamic acid group(group A,n=39)and control group(group B,n=42)according to whether using tranexamic acid,The operation of pedicle screw fixation,posterior laminectomy,bone plantation and lumbar interbody fusion were performed for all patients,the patients of group A were injected tranexamic acid(100 ml)into incision locally at the end of operation,while the group B did not receive that drug,then the drainage pipe will be clamped for 2 hours.V olume of the first 24 h and general drainage postoperative was compared and observed the morbidity of pulmonary embolism and deep vein thrombosis.Results It showed no statistically significant difference in age,gender,count of fusional segments,preoperative hematological result,duration of operation and intraoperative blood loss between the two groups(P>0.05),both volume of the first 24 h drainage and general drainage of group A was significantly lower than that in the group B(P<0.05).The pulmonary embolism and deep vein thrombosis were not found in the two groups.Conclusion The local medication of tranexamic acid at the end of posterior lumbar surgery,could reduce the postoperative blood loss significantly and not increase the risk of pulmonary embolism or deep vein thrombosis.

关 键 词：氨甲环酸 术后失血 退行性腰椎管狭窄 腰椎后路融合 

分 类 号：R681.5[医药卫生—骨科学]