左旋布比卡因联合氨甲环酸在脊柱后路手术中的应用效果  

Application of levobupivacaine combined with tranexamic acid in posterior spinal surgery

作　　者：汪锴 张小舟 康嗣如 阳仕雄 WANG Kai;ZHANG Xiao - zhou;KANG Si - ru;YANG Shi - xiong(Department of Orthopedics,Xiaogan Hospital Affiliated to Wuhan University of Science and Technology,Xiaogan 432000,Hubei,China)

机构地区：[1]武汉科技大学附属孝感医院骨三科,湖北孝感432000 [2]武汉科技大学附属孝感医院磁共振室,湖北孝感432000 [3]武汉科技大学附属孝感医院中心实验室,湖北孝感432000

出　　处：《广东医学》2019年第10期1419-1423,共5页Guangdong Medical Journal

基　　金：湖北省自然科学基金资助项目(编号:2018CFB786);湖北省卫健委联合基金项目(编号:WJ2019H250)

摘　　要：目的探讨左旋布比卡因联合氨甲环酸应用于脊柱后路手术的安全性与有效性。方法随机选取行胸腰椎后路手术的80例患者,使用随机数表法将其随机分为观察组(缝皮后局部浸润注射左旋布比卡因+氨甲环酸混合溶液20 mL)和对照组(缝皮后局部浸润注射生理盐水20 mL),分别检测患者术后3 d血红蛋白下降值、术后引流量、输血率、视觉模拟疼痛评分(visual analogue scale)、补救镇痛率、术后并发症发生率等指标。之后应用SPSS 19.0统计软件行统计学分析。结果观察组在术后6、12、24、48 h的VAS疼痛评分均低于对照组,差异有统计学意义(P<0.05)。观察组在术后0~11 h、12~23 h补救镇痛率要低于对照组,差异有统计学意义(P<0.05)。观察组的术后引流量要明显低于对照组,差异有统计学意义(P<0.05)。观察组在术后1、3 d血红蛋白量要明显高于对照组,差异有统计学意义(P<0.05)。两组的切口愈合时间和术后并发症发生率比较,差异均无统计学意义(P>0.05)。结论脊柱后路手术中局部应用左旋布比卡因联合氨甲环酸预防术后出血与术后疼痛兼具安全性和有效性,值得深入研究推广。Objective To assess the safety and efficacy of levobupivacaine with tranexamic acid in posterior spinal approach surgery. Methods Eighty patients who underwent thoracolumbar posterior surgery were prospectively randomly selected and divided into experimental group ( local injection of 20 mL mixed solution of levobupivacaine and tranexamic acid after suture) and control group ( local injection of 20ml saline after suture) by random number table. The decrease in hemoglobin,amount of post - operation drainage,transfusion rate,visual analogue scale,remedial analgesia rate and postoperative complications rate were recorded and compared on the 3rd day after surgery. The results were analyzed statistically using SPSS Statistics 19. 0 software. Results The VAS pain scores 6,12,24 and 48 hours after operation of in the experimental group were significantly lower than those in the control group ( P < 0. 05). The remedial analgesia rates 0 - 12 h and 12 - 24 h after operation in the experimental group was significantly lower than those in the control group ( P < 0. 05). The amount of post - operation drainage in experimental group was significantly less than that in the control group ( P < 0. 05). The amounts of hemoglobin on the 1st and 3rd day after operation in the experimental group were significantly higher than those in the control group ( P < 0. 05). No statistically significant differences in wound healing time and complications rate after the operation were found between the experimental group and the control group ( P > 0. 05). Conclusion The local application of levobupivacaine and tranexamic acid in spinal posterior surgery have a safety and higher effect in preventing postoperative bleeding.

关 键 词：左旋布比卡因 氨甲环酸 脊柱后入路手术 鸡尾酒疗法 

分 类 号：R61[医药卫生—外科学] R681.5[医药卫生—临床医学]