两种止血材料在腰椎退变手术中止血疗效的临床研究

目的观察评价可吸收流体明胶与明胶海绵在腰椎退变后路手术中的止血效果。方法前瞻性随机对照研究自2016年8月至2017年5月在本科收治的腰椎管减压固定融合的后路手术患者,随机分为两组:流体明胶组28例中,男12例,女16例;明胶海绵组27例中,男12例,女15例;术中分别应用流体明胶和(或)明胶海绵止血,如果出血速度逐渐减慢至不再有明显的出血即认为止血成功,否则视为止血失败。记录止血3 min、5min的止血成功率,记录手术时间、术中出血量、自体血回输量、止血过程中的出血量、输血量,记录术前、术后2～3 d和术后5～7 d的BP、RBC、HCT、HB的变化,记录术后每天的引流量,记录全部的不良事件。结果全部病例至少随访1个月。明胶海绵组有18例3 min成功止血、3例5 min成功止血,流体明胶组有21例3min内快速止血,3例5 min成功止血。两组止血过程中的出血量差异明显(P=0.000);术前流体明胶组RBC和HCT小于明胶海绵组(P=0.038,P=0.030),术后两组之间差异无统计学意义(P>0.05);术前两组收缩压差异无统计学意义(P>0.05),术后2～3 d流体明胶组收缩压比明胶海绵组高(P=0.005);流体明胶组的术后1 d和术后2～4 d的引流量均少于明胶海绵组(P=0.014;P=0.011)。结论与明胶海绵相比,可吸收流体明胶可以减少止血过程中的出血量,可以减少术后引流量,是一种安全、有效的脊柱外科术中止血剂。

Contrastive analysis of the hemostatic effect of two material during posterior procedure of lumbar degenerative disease

Objective To compare the hemostatic effect of hematostatic agent Surgiflo?and absorbable gelatin sponge during posterior lumbar surgery of lumbar degenerative disease.Methods The patients of lumbar degenerative disease were recruited during August 2016 and May 2017 according to the inclusion and exclusion criteria in this prospective,randomized and controlled study.Patients were randomly allocated to two groups by computer-generated randomization codes.All the patients were divided into Surgiflo?group(28 cases,using hematostatic agent Surgiflo?)and absorbable gelatin sponge(AGS)group(27 cases,using absorbable gelatin sponge).The success rates of hemostasis for 3 min and 5 min,the time of operation,the amount of intraoperative bleeding,the volume of autogenously blood transfusion,the amount of blood during hemostasis,the amount of blood transfusion,and BP,RBC,HCT,HB of preoperative,2~3 days and 5~7 days following operation were recorded to compare.Daily drainage and all adverse events after operation were also compared.Results All the patients were followed up for at least one month.In the AGS group,18 cases were successfully hemostatic in 3 min,3 cases were successful in 5 min.In Surgiflo?group,it is 21,and 3 cases respectively.There were significant difference of blood loss during hemostatic process between the two groups.The RBC and HCT of the Surgiflo?group were less than them of AGS group at preoperative time.But they were no difference between two groups after operation.The SBP of Surgiflo?group was higher than it of AGS groups at 2 to 3 days after operation,however,it was same before operation.The drainage volume on the 1 st day and the 2 nd to 4 th day after operation in Surgiflo?group was less than that in AGS group.Conclusion Compared with absorbable gelatin sponge,hematostatic agent Surgiflo?can significantly decrease the blood loss during hemostatic process and post-operative drainage in posterior operation of lumbar degenerative disease.The Surgical?is a safe and effective hemostatic agent in spinal surgery,and has a good application value in spinal canal hemostasis.