脊柱手术术前单次输注不同负荷剂量氨甲环酸的止血疗效观察  

Hemostatic effect of single infusion of tranexamic acid with different loading dose before spinal surgery: a comparative study

作　　者：刘沫轩 张红颖 袁建茹 闫辉 杨玉芬 LIU Moxuan;ZHANG Hongying;YUAN Jianru;YAN Hui;YANG Yufen(Fourth People1's Hospital of Lansang City,Affiliated Hospital of Chengde Medical College,Langfang 065700,China)

机构地区：[1]廊坊市第四人民医院/承德医学院附属医院,河北廊坊065700

出　　处：《中国输血杂志》2021年第4期362-365,共4页Chinese Journal of Blood Transfusion

基　　金：廊坊市科学技术研究与发展计划(2019013118)。

摘　　要：目的对比观察脊柱手术术前单次输注不同负荷剂量氨甲环酸的止血效果及安全性。方法脊柱侧弯矫形手术患者150例随机分为C组、H组及L组,各50例。手术切皮前,H组和L组分别静脉输注负荷剂量TXA 20 mg·kg^(-1)、10 mg·kg^(-1),而后持续静脉泵注TXA 10 mg·kg^(-1)·h^(-1)至术毕;C组相同时间点静脉输注等量0.9%氯化钠注射液。记录术中输液量、出血量、红细胞输注量、尿量及术后不同时点引流量。检测术前术后凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、D-二聚体(D-D)、血小板数量(BPC)、血红蛋白(Hb)、红细胞比容(HCT)、组织型纤溶酶原激活物(t-PA)和纤溶酶原激活物抑制剂^(-1)(PAI^(-1))。追踪术后下肢深静脉血栓(DVT)、肺栓塞、急性肾损伤(AKI)、癫痫、心肌梗死等不良事件。结果 H组、L组出血量、输血量低于C组(P<0.05),H组出血量、输血量低于L组(P<0.05)。3组术后1-3d引流量逐渐下降,H组、L组不同时点引流量均低于C组(P<0.05),H组不同时点引流量低于L组(P<0.05)。与术前比较,3组术后BPC、Hb、HCT下降(P<0.05),D-D、t-PA增高(P<0.05),H组、L组术后以上指标变化低于C组(P<0.05)、H组术后以上指标变化低于L组(P<0.05)。H组、L组术后PAI^(-1)无明显变化(P>0.05),而C组术后PAI^(-1)明显降低(P<0.05)。术后1 d、7 d、28 d双下肢B超检查未见DVT形成,术后28 d内追踪未发现肺栓塞、AKI、癫痫、心肌梗死等不良事件。结论脊柱手术中应用高负荷剂量TXA的止血效果更为突出,对术后近、远期不良事件的发生率亦无影响。Objective To compare the hemostatic effect and safety of single infusion of tranexamic acid with different loading dose before spinal surgery. Methods 150 patients with scoliosis orthopaedic surgery were randomly divided into group C, group H and group L with 50 cases in each group. Before skin incision, group H and group L received intravenous loading dose TXA of 20 mg/kg and 10 mg/kg, respectively, followed by continuous intravenous pumping of TXA of 10 mg/kg/h until the end of the operation. Group C received intravenous infusion of 0.9% sodium chloride injection at the same time. Intraoperative infusion volume, blood loss, red blood cell transfusion volume, urine volume and postoperative drainage volume were recorded. Prothrombin time(PT), activated partial prothrombin time(APTT), D-dimer(D-D), blood platelet count(BPC), hemoglobin(Hb), hematocrit(HCT), tissue plasminogen activator(t-PA) and plasminogen activator inhibitor^(-1)(PAI^(-1)) were detected before and after surgery. Adverse events such as lower extremity deep vein thrombosis(DVT), pulmonary embolism, acute kidney injury(AKI), epilepsy and myocardial infarction were followed. Results The amount of blood loss and transfusion in group H and group L was lower than that in group C(P<0.05), and that in group H was lower than that in group L(P<0.05).The drainage volume of the three groups decreased gradually from 1 to 3 days after the operation. The drainage volume of group H and group L at different time points was lower than that of group C(P<0.05), and that of group H at different time points was lower than that of group L(P<0.05). Compared with the preoperative results, the postoperative BPC, Hb and HCT in the three groups decreased(P<0.05), and the postoperative D-D and t-PA increased(P<0.05). The postoperative changes of the above indexes in group H and group L were lower than those in group C(P<0.05), and the postoperative changes of the above indexes in group H were lower than those in group L(P<0.05).There was no significant change in PAI^(-1) in

关 键 词：脊柱手术 氨甲环酸 负荷剂量 止血 D-二聚体 组织型纤溶酶原激活物 纤溶酶原激活物抑制剂-1 血栓 

分 类 号：R457.1[医药卫生—治疗学] R681.5[医药卫生—临床医学]