止血纱和氨甲环酸对颈后路全椎板减压术围术期出血及安全性的影响  

Effects of hemostatic gauze and tranexamic acid on perioperative hemorrhage and safety of posterior cervical decompressive laminectomy

作　　者：朱雷[1] 张鹰 王致远 田方 卢博涛 郝定均[1] 贾帅军 ZHU Lei;ZHANG Ying;WANG Zhiyuan;TIAN Fang;LU Botao;HAO Dingjun;JIA Shuaijun(Department of Spine Surgery,Honghui Hospital Affiliated to Xi′an Jiaotong University,Xi′an,Shaanxi,710054)

机构地区：[1]西安交通大学附属红会医院脊柱外科,陕西西安710054

出　　处：《实用临床医药杂志》2021年第12期32-36,共5页Journal of Clinical Medicine in Practice

基　　金：陕西省科学技术厅重点研发计划项目(2017ZDXM-SF-054);陕西省自然科学基础研究计划项目(2021JQ-925)。

摘　　要：目的比较静脉滴注氨甲环酸或局部应用止血纱对颈后路全椎板切除减压术患者围术期出血及安全性的影响。方法选取因脊髓型颈椎病行颈后路全椎板切除减压术的106例患者作为研究对象,随机分为氨甲环酸组(n=35)、止血纱组(n=35)和对照组(n=36)。对照组采用常规治疗,止血纱组术中在术区植入止血纱,氨甲环酸组术后静脉滴注氨甲环酸。比较3组总失血量、显性失血量、隐性失血量及术后总引流量,并比较3组术前及术后3 d时的血红蛋白、红细胞压积、血小板、凝血功能指标和炎症指标水平。结果止血纱组、氨甲环酸组的总失血量、显性失血量、隐性失血量及术后总引流量均少于对照组,且止血纱组少于氨甲环酸组,差异有统计学意义(P<0.05)。术后3 d时,3组血红蛋白、红细胞压积水平比较,差异无统计学意义(P>0.05);术后3 d时,3组D-二聚体、纤维蛋白原水平均高于术前,且氨甲环酸组D-二聚体、纤维蛋白原水平高于对照组、止血纱组,差异有统计学意义(P<0.05);术后3 d时,3组白细胞、中性粒细胞百分比、C反应蛋白水平比较,差异无统计学意义(P>0.05)。结论止血纱应用于颈后路全椎板切除术中的止血作用及安全性均优于氨甲环酸静脉滴注。Objective To compare the effects of intravenous infusion of tranexamic acid and local application of hemostatic gauze on perioperative hemorrhage and safety during posterior cervical decompressive laminectomy.Methods A total of 106 patients with cervical spondylotic myelopathy who underwent posterior cervical laminectomy and decompression were selected as study objects.The patients were randomly divided into tranexamic acid group(n=35),hemostatic group(n=35)and control group(n=36).The control group received conventional treatment,the hemostatic group was implanted hemostatic gauze in the operation area during the operation,and the tranexamic acid group received intravenous infusion of tranexamic acid after the operation.The total blood loss,apparent blood loss,invisible blood loss and postoperative total drainage volume were compared among the three groups.The hemoglobin,hematocrit,platelets,coagulation function indicators and inflammation related indicators of three groups before and 3 days after surgery were compared.Results Total blood loss,apparent blood loss,invisible blood loss and postoperative total drainage in the hemostatic group and tranexamic acid group were significantly less than those in the control group(P<0.05),and the above indicators of the hemostatic group were also significantly less than those of the tranexamic acid group(P<0.05).There were no significant differences in the levels of hemoglobin and hematocrit in the three groups at the third postoperative days(P>0.05).The D-dimer and fibrinogen levels at 3 d of the three groups were significantly higher than that of before operation,and the above indicators of the tranexamic acid group were higher than the control group and the hemostatic group(P<0.05).There were no statistically significant differences in the percentages of white blood cells,neutrophils,and C-reactive protein levels in the three groups at 3 days postoperation(P>0.05).Conclusion The hemostatic effect and safety of hemostatic gauze in posterior cervical decompressive laminect

关 键 词：颈后路手术 氨甲环酸 止血纱 出血 全椎板切除减压术 凝血功能 

分 类 号：R681.5[医药卫生—骨科学] R318[医药卫生—外科学]