静脉联合局部应用氨甲环酸对颈后路椎板切除减压后失血及炎症反应的影响  

Effects of intravenous and topical tranexamic acid on blood loss and inflammatory response after posterior cervical decompressive laminectomy

作　　者：谭昱波 夏英鹏[1] Tan Yubo;Xia Yingpeng(Tianjin union medical center,Tianjin Medical University,Tianjin 300000,China)

机构地区：[1]天津医科大学人民医院临床学院,天津市300000

出　　处：《中国组织工程研究》2024年第21期3367-3372,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:随着颈椎病发病率的升高,对于颈椎术后出血以及相关炎症反应的控制也显得尤为重要。目的:采用前瞻性研究,探讨颈后路椎板切除减压联合侧块螺钉内固定植骨融合过程中,静脉联合局部应用不同浓度氨甲环酸对术后失血以及炎症反应的影响。方法:以2020年1月至2022年12月在天津市人民医院因脊髓型颈椎病拟行颈后路椎板切除减压联合侧块螺钉内固定植骨的150例患者为研究对象,采用随机双盲抽签法将患者分为A、B、C组(n=50),分别于静脉联合局部应用1%,3%,5%氨甲环酸溶液。比较3组患者的术后失血及炎症相关指标,观察术后静脉血栓栓塞及血肿的发生情况。结果与结论:①3组患者术中出血量、总出血量以及隐性出血量等失血相关指标比较,差异均有显著性意义(P<0.01),B、C组均明显少于A组,且B、C组间差异无显著性意义(P>0.05);②3组患者术后第1,3天炎症指标包括血清C-反应蛋白、白细胞介素6与术前相比均有不同程度升高(P<0.05),随着用药浓度升高其表达降低,3组之间差异有显著性意义(P<0.001);③术后3组各出现2例肌间静脉血栓;3组术后均无血肿、肺栓塞等现象发生;④提示在颈后路椎板切除减压联合侧块螺钉内固定植骨融合过程中,静脉联合局部应用不同浓度氨甲环酸可有效达到降低失血以及炎症反应的效果,其中3%浓度的氨甲环酸达到相同效果的同时不会明显增加术后静脉血栓栓塞事件的发生风险。BACKGROUND:With the increase of the incidence of cervical spondylosis,it is particularly important to control the postoperative bleeding and related inflammatory reaction of cervical vertebra.OBJECTIVE:A prospective study was conducted to investigate the combined effect of intravenous and topical tranexamic acid of different concentrations on postoperative blood loss and inflammatory response during posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion.METHODS:From January 2020 to December 2022,150 patients who were scheduled to undergo posterior cervical decompressive laminectomy combined with lateral mass screw internal fixation and bone graft fusion for cervical spondylotic myelopathy in Tianjin People’s Hospital were enrolled in the study.Patients were divided into A,B,and C groups(n=50)by randomized double-blind lottery.The patients in the A,B,and C groups were treated with 1%,3%,and 5%intravenous and topical tranexamic acid solution,respectively.Postoperative blood loss and inflammation-related indicators were compared among three groups.The occurrence of venous thromboembolism and hematoma was observed after operation.RESULTS AND CONCLUSION:(1)There were significant differences in blood loss-related indexes,such as intraoperative blood loss,overall blood loss,and occult blood loss among the three groups(P<0.01).The above indexes were significantly lower in groups B and C than that in group A.There was no significant difference between groups B and C(P>0.05).(2)On days 1 and 3 after surgery,the levels of inflammatory indicators including serum C-reactive protein and interleukin-6 were increased to varying degrees in the three groups compared to before surgery(P<0.05).As the drug concentration increased,its expression decreased,and there was a significant difference among the three groups(P<0.001).(3)Two cases of intramuscular venous thrombosis appeared in each of the three groups after surgery.No hematoma or pulmonary embolism occurred in all

关 键 词：氨甲环酸 颈后路椎板切除减压 围术期 出血量 炎症反应 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R681.5