氨甲环酸对腰椎后路椎体间融合术后引流管拔除时机及疗效的影响  

Influence of tranexamic acid on the removal timing of drainage tube and efficacy of posterior lumbar interbody fusion

作　　者：李毅 仝路[1] 武刚 张开 贾海栋 江丽强[1] LI Yi;TONG Lu;WU Gang;ZHANG Kai;JIA Hai-dong;JIANG Li-qiang(Section Ⅰ,Dept of Orthopaedics,the Central Hospital of Handan City,Handan,Hebei 056002,China)

机构地区：[1]邯郸市中心医院骨一科,河北邯郸056002

出　　处：《临床骨科杂志》2023年第6期778-781,共4页Journal of Clinical Orthopaedics

基　　金：河北省邯郸市科技局研究与发展计划项目(编号:1823208035ZC)。

摘　　要：目的探讨应用氨甲环酸对腰椎后路椎体间融合术(PLIF)术后引流管拔除时机及疗效的影响。方法将120例行PLIF治疗的患者按照随机数字表法分为A组(仅切皮前30 min静脉滴注氨甲环酸)、B组(切皮前30 min静脉滴注氨甲环酸,关闭切口30 min后再次静脉滴注氨甲环酸)、C组(仅切皮前30 min静脉滴注生理盐水)、D组(切皮前30 min静脉滴注生理盐水,关闭切口30 min静脉滴注生理盐水),每组30例。A、B组氨甲环酸用量为15 mg/kg,加入100 ml生理盐水中,30 min内静脉滴注完毕。记录4组手术相关指标、疼痛VAS评分、ODI以及术后并发症发生情况。结果患者均获得3个月随访。①术中出血量、总失血量、术后引流量、隐性失血量、术后拔除引流管时间:A、B组均少(短)于C、D组(P<0.05);除术中出血量A组与B组比较差异无统计学意义(P>0.05)外,其他指标B组均少(短)于A组(P<0.05)。②疼痛VAS评分及ODI:拔管后A、B组均低于C、D组(P<0.05),A、B组两组比较差异均无统计学意义(P>0.05);术后3个月4组间比较差异均无统计学意义(P>0.05)。4组均未发生深静脉血栓形成,仅D组1例发生单侧小腿肌间静脉血栓形成;C、D组各1例发生引流管切口端细菌培养阳性,C组3例发生切口红肿。结论PLIF术前及术后应用氨甲环酸能缩短留置引流管时间,减少术后引流量、隐性失血量及总失血量,减轻患者术后早期疼痛、促进腰椎功能恢复。Objective To investigate the effect of tranexamic acid on the timing of drainage tube removal and efficacy of posterior lumbar interbody fusion(PLIF).Methods According to the random number table method,120 PLIF patients were divided into group A(only trantranic acid was injected intravenously at 30 min before dermectomy)and group B(trantranic acid was injected intravenously at 30 min before dermectomy,and 30 min after the incision closure,trantranic acid was injected intravenously again),group C(only normal saline was injected intravenously 30 min before dermectomy),group D(normal saline was injected intravenously 30 min before dermectomy,and normal saline was injected intravenously 30 min after the incision closure),with 30 cases in each group.The dosage of tranexamic acid in group A and group B was 15 mg/kg,which was added into 100 ml normal saline,and intravenous injection was completed within 30 min.Operation-related indicators,pain VAS,ODI and postoperative complications were recorded in the four groups.Results All patients were followed up for 3 months.①The intraoperative blood loss volume,total blood loss,postoperative drainage volume,hidden blood loss,postoperative drainage tube removal time:group A,B were less(shorter)than group C,D(P<0.05);except for intraoperative blood loss volume had no statistical difference between group A,B(P>0.05),the other indicators in group B were all less(shorter)than those in group A(P<0.05).②Pain VAS and ODI:after extubation,group A,B were lower than group C,D(P<0.05),and there was no statistical significance between group A and B(P>0.05).Three months after surgery,there was no statistical difference among the four groups(P>0.05).No deep vein thrombosis was found in the four groups,and only 1 case of group D developed unilateral calf intermuscular vein thrombosis.There was positive bacterial culture at the incision end of drainage tube in 1 case of group C,D,and 3 cases of group C had incision redness and swelling.Conclusions The application of tranatemic acid before an

关 键 词：氨甲环酸 腰椎后路椎体间融合术 引流量 感染 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学] R973.1[医药卫生—临床医学]