氨甲环酸应用于胸腰椎骨折前路手术的有效性与安全性评价  

Efficacy and safety of tranexamic acid in anterior approach surgery for thoracolumbar fractures

作　　者：黄勇[1] 黄雷震 丰干钧[1] 刘立岷[1] 宋跃明[1] HUANG Yong;HUANG Leizhen;FENG Ganjun;LIU Limin;SONG Yueming(Department of Orthopedic Surgery/Orthopedic Research Institute,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院骨科/骨科研究所,成都610041

出　　处：《华西医学》2020年第10期1164-1169,共6页West China Medical Journal

基　　金：国家自然科学基金(81572160)。

摘　　要：目的探讨氨甲环酸应用于胸腰椎骨折前路手术的止血效果与安全性。方法选取2017年1月—2020年1月四川大学华西医院前路手术治疗的胸腰椎骨折患者68例,随机分为氨甲环酸组33例和对照组35例。氨甲环酸组分别于术前30 min及间隔8 h后静脉输注氨甲环酸15 mg/kg,对照组在相同时间节点输注等量生理盐水。收集患者基本资料,监测患者术前、术后24 h及术后72 h血红蛋白浓度、红细胞比容、凝血及纤溶指标,记录患者术中失血量、伤口引流量、输血及血栓发生情况,并进行相关统计学分析。结果氨甲环酸组与对照组患者在年龄、性别、体质量指数、手术时间、骨折位置分布、麻醉分级、脊髓损伤分级、受伤时间及住院时间方面差异均无统计学意义(P>0.05)。氨甲环酸组与对照组患者总失血量[(1398.49±312.24)vs.(1642.30±357.78)mL,P=0.003]、术中失血量[(432.83±74.76)vs.(486.31±86.51)mL,P=0.008]及伤口引流量[(276.73±89.42)vs.(389.24±125.71)mL,P<0.001]差异有统计学意义。术前两组血红蛋白浓度与红细胞比容差异无统计学意义(P>0.05),术后24 h氨甲环酸组血红蛋白[(112.67±20.59)vs.(102.64±19.41)g/L,P=0.042]和红细胞比容[(32.25±4.12)%vs.(30.13±4.28)%,P=0.042]均高于对照组。氨甲环酸组与对照组异体输血发生率分别为6.1%和25.7%,差异有统计学意义(P<0.05)。两组患者的凝血酶原时间、国际标准化比值、活化部分凝血活酶时间、血小板计数、纤维蛋白原、D-二聚体及纤维蛋白原降解产物在术前、术后24 h及72 h比较差异无统计学意义(P>0.05)。未发现任何血栓相关并发症。结论氨甲环酸应用于胸腰椎骨折前路手术治疗具有良好的止血效果与安全性。Objective To explore the effectiveness and safety of tranexamic acid(TXA)in anterior approach surgery for thoracolumbar fractures.Methods From January 2017 to January 2020,a total of 68 thoracolumbar fracture patients undergoing anterior approach surgery were included and randomly divided into TXA group(n=33)and control group(n=35).Patients in the TXA group were given a dose of 15 mg/kg of TXA by intravenous infusion during 30 min before skin incision and an additional 15 mg/kg of TXA intravenously at 8 h after the first infusion,while the ones in the control group were given 15 mg/kg of normal saline at the same time.Basic data of the patients were collected.The hemoglobin concentration,hematocrit,coagulation and fibrinolysis indexes of the patients were monitored preoperatively,24-hour postoperatively,and 72-hour postoperatively.The intraoperative blood loss and wound drainage of the patients were recorded.The incidence of blood transfusion and thrombotic events were collected.Statistical analysis was performed.Results There was no significant difference in age,sex,body mass index,operation time,fracture location distribution,anesthesia classification of American Society of Anesthesiologists,neurologic grade of American Spinal Injury Association,injury time,or length of hospital stay between the two groups(P>0.05).Compared with those in the control group,the total blood loss[(1398.49±312.24)vs.(1642.30±357.78)mL,P=0.003],intraoperative blood loss[(432.83±74.76)vs.(486.31±86.51)mL,P=0.008],and wound drainage[(276.73±89.42)vs.(389.24±125.71)mL,P<0.001]in the TXA group reduced.No statistically significant difference was found between the two groups in the preoperative hemoglobin or hematocrit(P>0.05),but the 24-hour postoperative hemoglobin concentration[(112.67±20.59)vs.(102.64±19.41)g/L,P=0.042]and hematocrit[(32.25±4.12)%vs.(30.13±4.28)%,P=0.042]in the TXA group were higher than those in the control group.The incidence of allogeneic blood transfusion in the TXA group was lower than that in the control

关 键 词：氨甲环酸 前路手术 胸腰椎骨折 

分 类 号：R687.3[医药卫生—骨科学]