氨甲环酸术前足量单剂给药对多节段腰椎后路椎间融合术失血量及安全性的影响

目的 探讨氨甲环酸(TXA)术前足量单剂给药对多节段腰椎后路椎间融合术(PLIF)失血量及安全性的影响.方法 回顾分析2017年3月至2019年12月本院接受多节段PLIF的腰椎管狭窄症患者105例.根据干预方法 分为对照组、A组和B组(n分别=30、39、36).对照组不使用TXA;A组术前30 min静脉滴注含2g...

Effect of adequate amount of tranexamic acid before operation on blood loss and safety in posterior lumbar fusion with multiple segments

Objective To investigate the effect of adequate amount of tranexamic acid(TXA)before operation on blood loss and safety in posterior lumbar fusion with multiple segments. Methods A retrospective analysis was conducted on 105 patients with lumbar spinal stenosis, submitted to our hospital for multilevel PLIF, from March 2017 to December 2019. According to the intervention method, they were divided into control group, group A and group B(n =30, 39 and 36, respectively). TXA was not used in the control group. Dripping of saline solution(100 mL) containing TXA 2 g and 1 g was given in Group A and Group B, and extra intravenous pumping of TXA [10 mg/(kg·h)] during surgery was conducted in Group B besides the pre-operation dripping of TXA. Total blood loss, dominant blood loss, recessive blood loss, intraoperative blood loss, postoperative drainage volume, transfusion rate and hemoglobin(Hb), hematocrit(Hct), prothrombin time international standardized ratio(PT-INR), platelet count(Plt), D-dimer(D-D), C-reactive protein(CRP), neutrophil percentage(NP), alanine aminotransferase(ALT), and blood urea nitrogen(BUN) before and after operation were compared in the three groups. Postoperative drug-related adverse events were traced.Results 1)The total blood loss, dominant blood loss(mL), intraoperative blood loss(mL), drainage volume(mL) within and after 24 h after surgery, and the transfusion rate(%) in group A and B were 892.6±193.5 vs 887.7±320.8, 409.1±109.2 vs,408.6±98.3, 193.7±69.3 vs 189.6±65.6, 130.5±53.4 vs 128.3±53.5, 63.1±17.6 vs 60.9±13.5 and 7.7(3/39) vs 8.3(3/36), respectively, which were significantly lower than that in group C as 1 296.8±329.2, 807.6±231.5, 270.9±65.5, 365.4±127.8, 172.3±66.4 and 36.7(11/30), respectively(P< 0.05). There were no significant differences in the above indexes between group A and group B(P < 0.05). The differences in recessive blood loss was not significant by groups(P<0.05). 2) Compared with pre-operation, the levels of Hb, Hct and Plt in the three groups at 3 d after operation decreased: Hb(g/L) 91.5±14.0, 107.6±16.4 and 105.9±17.1;Hct(%) 25.6±3.1, 31.2±3.9 and 30.5±4.4;Plt(×10~9/L)146.6±31.8, 172.8 ±40.1 and 169.7±39.5(P < 0.05);while D-D, CRP and NP increased: D-D(mmol/L)365.6±67.1, 280.9±50.5 and 286.1±53.1;CRP(mg/L): 65.4±22.0, 53.4±19.6 and 56.8±17.7;NP(%): 87.3±15.6, 73.1±13.7, and 71.9±11.8(P < 0.05), and Pt-INR, ALT and BUN showed no significant changes(P > 0.05). The changes of Hb, Hct, Plt, D-D, CRP and NP in group A and B were significantly lower than those in group C at 3 days after operation [Hb(g/L) : 107.6±16.4, 105.9±17.1, 91.5±14.0;Hct(%) : 31.2±3.9, 30.5±4.4,25.6±3.1;Plt(×10~9/L) : 172.8 ±40.1, 169.7±39.5, 146.6±31.8;D-D(mmol/L) : 280.9±50.5, 286.1±53.1, 365.6±67.1;CRP(mg/L) : 53.4±19.6, 56.8±17.7, 65.4±22.0;NP(%) :73.1±13.7, 71.9±11.8, 87.3±15.6](P < 0.05), and no significant differences in the above index were noticed between group A and B(P> 0.05).3)No lower limb deep vein thrombosis nor pulmonary embolism were found in group A and group B after operation, and all the incisions were healed in the first stage, and no serious complications such as drug allergy, cardiovascular and cerebrovascular accident, epidural hematoma, epilepsy occurred. Conclusion The preoperative TXA administration with sufficient single dose showed equivalent hemostatic effect in comparison with intraoperative continuous administration additional to preoperative dripping, which is simple and convenient and does not increase the risk of thrombosis.