氨甲环酸联合控制性降压对脊柱手术出血的影响  

Effects of tranexamic acid and controlled hypotension on hemorrhage in spinal surgery

作　　者：杨惠鸿 闫磊[1] 徐桂萍[1] YANG Hui-hong;YAN Lei;XU Gui-ping(Department of Anesthesiology,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi,Xinjiang 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院麻醉科,新疆乌鲁木齐830001

出　　处：《中华全科医学》2022年第6期927-930,981,共5页Chinese Journal of General Practice

基　　金：新疆维吾尔自治区自然科学基金项目(2017D01C137)。

摘　　要：目的探究氨甲环酸联合控制性降压对脊柱手术出血的影响。方法选择2019年1月—2020年2月新疆维吾尔自治区人民医院择期脊柱手术患者120例,采用随机数字表法随机分为3组:对照组(S组)、氨甲环酸组(TXA组)、氨甲环酸联合控制性降压组(TXA+CH组),各40例。S组切皮即刻静脉注射生理盐水0.2 mL/kg,术中以0.1 mL/(kg·h)的速率泵注至术毕。TXA组注射氨甲环酸20 mg/kg,术中以10 mg/(kg·h)的速率泵注至术毕。TXA+CH组在TXA组基础上,泵注硝普钠行控制性降压至主要手术完成。记录术前、术后1 d的各项指标及术后1周不良事件发生情况等。结果与S组相比,TXA组和TXA+CH组术中出血量[(434.2±73.4)mL vs.(287.6±73.6)mL vs.(236.2±59.4)mL]、术后24小时引流量[110.0(91.3,145.0)mL vs.77.5(60.0,95.0)mL vs.60.0(50.0,70.0)mL]、术中视野质量评分[(3.3±0.5)分vs.(2.4±0.5)分vs.(2.2±0.4)分]、住院时间[8.5(7.0,15.0)d vs.6.5(5.0,9.0)d vs.6.0(5.0,7.8)d]差异均有统计学意义(均P<0.05);与TXA组相比,TXA+CH组术中出血量和手术视野质量评分降低(均P<0.05),术后24小时引流量和住院时间比较差异无统计学意义(均P>0.05)。3组患者术前各生化指标比较差异均无统计学意义(均P>0.05);术后1 d 3组患者RBC、Hb、HCT差异有统计学意义(均P<0.05)。3组患者均未发生不良反应。结论氨甲环酸可以减少脊柱手术出血量,而且联合控制性降压的效果更佳。Objective To investigate the effect of tranexamic acid combined with controlled hypotension on perioperative bleeding after spinal surgery.Methods A total of 120 spinal surgery patients in the People's Hospital of Xinjiang Uygur Autonomous Region from January 2019 to February 2020 were selected and divided into 3 groups by random number table method:S group,TXA group and TXA+CH group.In S group,0.2 mL/kg of normal saline was intravenously injected immediately after anesthesia induction,and was pumped at a rate of 0.1 mL/(kg·h)until the end of surgery.TXA group was injected with tranexamic acid 20 mg/kg at a rate of 10 mg/(kg·h)by intravenous pump until the end of operation.In the TXA+CH group,on the basis of the TXA group,sodium nitroprusside was pumped for controlled blood pressure until the main operation was completed.The indicators before and 1 day after operation and the occurrence of adverse events in one week after operation were recorded.Results Compared with S group,intraoperative blood loss in TXA group and TXA+CH group[(434.2±73.4)mL vs.(287.6±73.6)mL vs.(236.2±59.4)mL],postoperative drainage volume[110.0(91.3,145.0)mL vs.77.5(60.0,95.0)mL vs.60.0(50.0,70.0)mL],intraoperative visual field quality score[(3.3±0.5)points vs.(2.4±0.5)points vs.(2.2±0.4)points],days of hospitalization[8.5(7.0,15.0)d vs.6.5(5.0,9.0)d vs.6.0(5.0,7.8)d],the differences were statistically significant(all P<0.05).Compared with TXA group,intraoperative blood loss and SSFQ score of TXA+CH group were decreased(all P<0.05),and there was no significant difference in the length of hospital stay and 24-hour postoperative drainage volume(all P>0.05).There was no statistical significance in the biochemical indexes between the three groups before operation(all P>0.05).There were differences in RBC,HB,and HCT among the three groups at 1 d after operation(all P<0.05).There were no adverse reactions in the three groups of patients.Conclusion Tranexamic acid can reduce blood loss in patients undergoing spinal surgery,and tranexamic ac

关 键 词：氨甲环酸 控制性降压 脊柱手术 血液保护 

分 类 号：R681.5[医药卫生—骨科学] R614.24[医药卫生—外科学]