不同负压引流方式联合氨甲环酸对颈椎后路单开门手术病人失血量、引流量及并发症的影响  

Effects of different negative pressure drainage methods combined with tranexamic acid on blood loss,drainage volume and complications in patients with posterior cervical single-door surgery

作　　者：刘红正[1] 郜顺兴 张楠 LIU Hongzheng;GAO Shunxing;ZHANG Nan(Department I of Spinal Surgery,Cangzhou Hospital of Integrated Traditional and Western Medicine,Cangzhou,Hebei 061000,China)

机构地区：[1]沧州中西医结合医院脊柱脊髓外一科,河北沧州061000

出　　处：《安徽医药》2024年第5期920-924,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探究不同负压引流方式联合氨甲环酸对颈椎后路单开门手术的多节段脊髓型颈椎病病人失血量、引流量及并发症的影响。方法按照研究目标设定的纳入、排除标准,将2018年10月至2020年10月沧州中西医结合医院接受颈椎后路单开门手术的多节段脊髓型颈椎病病人182例作为研究对象进行回顾性研究,根据负压引流情况分为A组(持续负压引流联合氨甲环酸,46例)、B组(间断负压引流联合氨甲环酸,46例)、C组(持续负压引流,不使用氨甲环酸,45例)及D组(间断负压引流,不使用氨甲环酸,45例)。对比四组病人手术时间、总失血量、术后引流量、术后72 h血红蛋白水平,生化指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)],术后疼痛视觉模拟评分(VAS)及日本骨科协会评估治疗分数(JOA)评分。结果手术后,四组手术时间、总失血量比较差异无统计学意义(P>0.05),四组术后24 h引流量[A组(191.21±22.38)mL、B组(175.34±17.85)mL、C组(205.62±20.78)mL、D组(210.43±20.14)mL]、术后隐性失血量[A组(275.37±30.12)mL、B组(251.42±26.12)mL、C组(321.47±35.62)mL、D组(296.78±32.14)mL]、引流管留置时间[A组(1.85±0.51)d、B组(1.45±0.42)d、C组(2.32±0.65)d、D组(2.78±0.78)d]比较差异有统计学意义(P<0.05),其中B组最优,其次为A组。四组术后72 h血红蛋白水平[A组(112.43±12.57)g/L、B组(120.53±17.85)g/L、C组(103.47±10.78)g/L、D组(102.58±11.12)g/L]均明显降低(P<0.05),但是B组下降最少,其次为A组。四组血清APTT、PT、Fib水平差值比较差异有统计学意义(P<0.05),其中A组各指标变化最明显,B组血清APTT水平变化最小;四组VAS评分与JOA评分比较差异无统计学意义(P>0.05);四组发热、脑脊液漏、血肿压迫脊髓、下肢深静脉血栓、心血管事件等并发症发生情况比较差异无统计学意义(P>0.05)。结论颈椎后路单开门手术中应用间断负压引流联合�Objective To explore the effect of different negative pressure drainage methods combined with tranexamic acid on the blood loss,drainage volume and complications of multisegmental cervical spondylotic myelopathy patients undergoing posterior cervi⁃cal single-door surgery.Methods According to the inclusion and exclusion criteria set by the research objectives,a total of 182 pa⁃tients of multisegmental cervical spondylotic myelopathy,who underwent cervical posterior single door operation in Cangzhou Hospital of Integrated Traditional and Western Medicine from October 2018 to October 2020,were selected as research subjects for a retrospec⁃tive study.They were assigned into group A(continuous negative pressure drainage combined with tranexamic acid,46 cases),group B(intermittent negative pressure drainage combined with tranexamic acid,46 cases),group C(continuous negative pressure drainage without using tranexamic acid,45 cases)and group D(intermittent negative pressure drainage without using tranexamic acid,45 cases)according to the negative pressure drainage.The operation time,total blood loss,postoperative drainage volume,72 h postoperative he⁃moglobin level,biochemical indexes[activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(Fib)],postopera⁃tive pain visual analogue scale(VAS)and Japanese Orthopaedic Association(JOA)score were compared among the four groups.Re⁃sults After the operation,there were no significant differences in the operation time and total blood loss among the 4 groups(P>0.05).Drainage volumes at 24 hours after operation[group A:(191.21±22.38)mL,group B:(175.34±17.85)mL,group C:(205.62±20.78)mL,group D:(210.43±20.14)mL],postoperative hidden blood loss[group A:(275.37±30.12)mL,group B:(251.42±26.12)mL,group C:(321.47±35.62)mL,group D:(296.78±32.14)mL],and indwelling time of drainage tube[group A:(1.85±0.51)d,group B:(1.45±0.42)d,group C:(2.32±0.65)d,group D:(2.78±0.78)d]were found to be statistically different(P<0.05),among which group B was the bes

关 键 词：颈椎 椎管 持续负压引流 颈椎后路单开门手术 氨甲环酸 凝血酶原时间 间断负压引流 

分 类 号：R687.3[医药卫生—骨科学]