双节段PLIF手术前后应用氨甲环酸减少围术期失血的疗效分析  

Analysis on efficacy of using tranexamic acid before and after double-segment PLIF in reducing perioperative blood loss

作　　者：高阳[1] 王勇[1] 刘阳[1] 杨枭雄 吴坤 GAO Yang;WANG Yong;LIU Yang;YANG Xiaoxiong;WU Kun(Department of Orthopedics,Peking University Third Hospital,Beijing 100089,China)

机构地区：[1]北京大学第三医院骨科,100089

出　　处：《重庆医学》2022年第12期2079-2083,共5页Chongqing medicine

摘　　要：目的探讨双节段腰椎后路减压椎间植骨融合术(PLIF)术前静脉给药、术中伤口喷洒联合术后静脉输入氨甲环酸(TXA)对于减少围术期失血的疗效。方法选择该院骨科2021年1-6月收治的100例行双节段PLIF的患者,将其分为观察组和对照组,每组50例。观察组分别术前使用TXA 1 g加入100 mL生理盐水中静脉滴注,术中用TXA 1 g对切口局部进行浸润喷洒,术后第2天继续静脉滴注TXA 1 g,每天1次,连续使用3 d;对照组术中及术后不使用TXA,而使用生理盐水代替。比较两组患者一般情况、术前及术后血红蛋白(Hb)水平、术中失血量、引流管拔出时间、住院时间、术后引流量情况。同时检测两组患者凝血功能相关指标,出院前完善双下肢静脉血管超声,观察有无深静脉血栓(DVT)形成。结果术前两组患者一般情况比较差异无统计学意义(P>0.05)。观察组患者术后24 h内引流量及总引流量明显低于对照组[(132.93±29.59)mL vs.(261.84±48.62)mL,(365.62±42.13)mL vs.(587.38±31.93)mL,P<0.05];术后拔管时间及出院时间明显短于对照组[(2.65±0.52)d vs.(4.37±0.41)d,(4.50±0.43)d vs.(6.62±0.37)d,P<0.05]。观察组患者手术前后Hb减少量低于对照组[(8.31±2.84)g/L vs.(15.33±5.10)g/L,P<0.05]。两组患者术后均无下肢静脉血栓形成,术后DVT的发生率比较差异无统计学意义(P>0.05)。结论术前静脉使用、术中伤口喷洒联合术后继续静脉使用TXA可明显减少PLIF围术期出血量,缩短拔管及出院时间,且未增加DVT风险。Objective To investigate the efficacy of preoperative intravenous administration,intraoperative wound spraying combined with postoperative intravenous infusion of tranexamic acid(TXA)for dual-segment posterior lumbar interbody fusion(PLIF)in reducing perioperative blood loss.Methods A total of 100 patients who underwent double-segment PLIF in the Department of Orthopedic of this hospital from January to June 2021 were selected and divided into the observation group and control group,50 cases in each group.In the observation group,1 g of TXA was added to 100 mL of normal saline for intravenous drip before operation,and 1 g of TXA was used to infiltrate and spray the incision area during the operation.On the second day after the operation,1 g of TXA was continued to be intravenously dripped,once a day,for consecutive 3 d.The control group did not use TXA during and after operation,but which was replaced with normal saline.The general conditions,preoperative and postoperative hemoglobin(Hb)levels,intraoperative blood loss,drainage tube pull-out time,hospital stay,and postoperative drainage volume were compared between the two groups.At the same time,the coagulation function related indexes were detected,and the ultrasound of the venous blood vessels of both lower extremities was perfected before discharge to observe whether the formation of deep vein thrombosis(DVT)or not.Results There was no statistically significant difference in the general conditions before surgery between the two groups(P>0.05).The drainage volume within postoperative 24 h and total drainage volume in the observation group were significantly lower than those in the control group[(132.93±29.59)mL vs.(261.84±48.62)mL,(365.62±42.13)mL vs.(587.38±31.93)mL,P<0.05].Thepostoperative extubation time and discharge time in the observation group were significantly shorter than those in the control group[(2.65±0.52)d vs.(4.37±0.41)d,(4.50±0.43)d vs.(6.62±0.37)d,P<0.05].The reduction of Hb before and after the operation in the observation group was

关 键 词：氨甲环酸 双节段 腰椎后路减压椎间植骨融合术 围手术期 失血量 

分 类 号：R687.3[医药卫生—骨科学]