静脉联合局部灌洗氨甲环酸对强直性脊柱炎胸腰段骨折术中术后出血量的影响  

Effect of intravenous combined with topical application of tranexamic acid on intraoperative and postoperative blood loss of thoracolumbar fractures in ankylosing spondylitis

作　　者：丁柯元 陈浩[1,2] 田野 郝定均[1] DING Keyuan;CHEN Hao;TIAN Ye;HAO Dingjun(Department of Spinal Surgery,Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University,Xi′an,Shaanxi 710054,China;Xi′an Medical University,Xi′an,Shaanxi 710021,China)

机构地区：[1]西安交通大学附属西安市红会医院脊柱外科,西安710054 [2]西安医学院,西安710021

出　　处：《重庆医学》2020年第14期2270-2274,共5页Chongqing medicine

基　　金：国家自然科学基金项目(81830077)。

摘　　要：目的探讨强直性脊柱炎(AS)胸腰段骨折后路切开复位内固定手术前后静脉联合局部使用氨甲环酸(TXA)对出血的影响。方法回顾性分析2017年1月至2019年1月因AS胸腰段骨折于西安交通大学附属西安市红会医院行后路切开复位内固定手术治疗的93例患者资料。其中,53例患者纳入TXA组,切皮前30 min静脉滴注第1剂TXA(15 mg/kg),术毕缝合切口前TXA溶液(1000 mg TXA+0.9%氯化钠溶液50 mL)创口内灌洗,手术结束后12 h静脉滴注第2剂氨甲环酸(15 mg/kg);40例患者纳入对照组,围术期未使用TXA。观察两组患者术中出血量、术后24 h引流量、总出血量、输血率,以及术前和术后第1天血液学指标。结果TXA组患者术中出血量[(453±139)mL vs.(624±170)mL]、术后24 h引流量[(108±44)mL vs.(184±48)mL]和总出血量[(561±179)mL vs.(808±210)mL]明显少于对照组(P<0.05)。TXA组围术期输血率明显低于对照组(5.7%vs.27.5%,P<0.05)。术前两组患者血液学各指标水平无明显差异(P>0.05);术后TXA组血红蛋白、血小板及红细胞压积水平高于对照组,差异有统计学意义(P<0.05)。两组术后均无血栓栓塞并发症发生。结论TXA静脉滴注联合创口内灌洗能减少AS胸腰段骨折患者围术期出血量及输血率。Objective To explore the effect of intravenous combined with topical application of tranexamic acid(TXA)on bleeding before and after posterior open reduction and instrumentation surgery in ankylosing spondylitis(AS)patients complicated with thoracolumbar fractures.Methods A retrospective analysis of the data of 93 patients with AS who underwent posterior open reduction and instrumentation surgery for the treatment of thoracolumbar fractures in Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University from January 2017 to January 2019 was conducted.Among them,53 patients were enrolled in the TXA group.The first dose of TXA(15 mg/kg)was intravenously administered to them 30 min before the incision,then the wound was irrigated with TXA solution(1000 mg TXA+0.9%sodium chloride solution 50 mL)before closing the surgical incision,and the second dose of TXA(15 mg/kg)was intravenously administered 12 h after the operation.The other 40 patients were enrolled into the control group,and TXA was not used during the perioperative period.The intraoperative blood loss,drainage volume at 24 h after operation,total blood loss and blood transfusion rate were observed in the two groups,and the hematological parameters before and after the operation were recorded,as well.Results The intraoperative blood loss[(453±139)mL vs.(624±170)mL],drainage volume at 24 h after operation[(108±44)mL vs.(184±48)]and total blood loss[(561±179)mL vs.(808±210)mL]in the TXA group were significantly lower than those in the control group(P<0.05).The perioperative blood transfusion rate in the TXA group was significantly lower than that in the control group(5.7%vs.27.5%,P<0.05).There was no significant difference in the levels of hematology indexes between the two groups before operation(P>0.05),and the postoperative levels of hemoglobin,platelets and hematocrit in the TXA group were higher than those in the control group(P<0.05).No thromboembolic complication occurred in both groups.Conclusion Intravenous application combined with local l

关 键 词：脊柱炎 强直性 脊柱骨折 氨甲环酸 骨折 出血 输血 

分 类 号：R593.23[医药卫生—内科学] R605[医药卫生—临床医学]