氨甲环酸在老年腰椎椎管狭窄症患者围手术期血液管理中的作用

目的探讨老年多节段腰椎椎管狭窄症(LSS)患者围手术期使用氨甲环酸的安全性及其在降低总出血量、显性出血量、隐性出血量及输血量方面的临床效果。方法 2017年3月—2018年6月,前瞻性随机双盲将巴中市通江新区医院收治的34例需行后路椎板切除椎间融合术的LSS患者分为2组。氨甲环酸组(18例)麻醉成功后一次性静脉滴注氨甲环酸氯化钠注射液(100 mL∶1 g)1 g,手术结束前使用氨甲环酸氯化钠注射液(100 mL∶1 g)1 g局部冲洗创面;对照组(16例)麻醉成功后给予生理盐水100 mL静脉滴注。记录2组患者围手术期红细胞(RBC)、红细胞压积(HCT)、血红蛋白(HGB)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原(FIB)、总出血量、显性出血量、隐性出血量及输血量,并进行对比分析。结果所有患者术后切口甲级愈合,均未发生深静脉血栓、脑梗死等并发症。2组患者术前RBC、HCT、HGB、PT、APTT及FIB差异无统计学意义(P 0.05);术后1 h、72 h氨甲环酸组患者RBC、HCT及HGB均明显高于对照组,差异有统计学意义(P 0.05);氨甲环酸组总出血量、显性出血量、隐性出血量及输血量均低于对照组,差异有统计学意义(P 0.05)。结论围手术期使用氨甲环酸对老年LSS患者的血液管理具有积极作用,可以减少围手术期总出血量、显性出血量、隐性出血量及输血量。

Role of tranexamic acid in perioperative blood management of elderly patients with lumbar spinal stenosis

Objective To study the clinical effect of tranexamic acid for reducing total blood loss, dominant blood loss, hidden blood loss and blood transfusion volume during the perioperative period in elderly patients with multiple segments lumbar spinal stenosis(LSS). Methods From March 2017 to June 2018, 34 patients admitted to Tongjiang District Hospital in Bazhong with LSS requiring posterior laminectomy and interbody fusion were randomly divided into 2 groups. In the tranexamic acid group(18 cases), after successful anesthesia, tranexamic acid and sodium chloride injection(100 mL:1 g) was infused in travenously at a dose of 1 g; before the end of operation, tranexamic acid and sodium chloride injection(100 mL:1 g) was used to wash the wound locally. The control group(16 cases) received 100 mL saline by intravenous drip after successful anesthesia. Perioperative red blood cell(RBC), hematocrit(HCT), hemoglobin(HGB), prothrombin time(PT), activated partial thromboplastin time(APTT), fibrinogen(FIB), total blood loss, overt blood loss, occult blood loss and blood transfusion were recorded and compared between the 2 groups. Results All the patients had excellent incision healing, and no complications such as deep venous thrombosis or cerebral infarction occurred. There was no significant difference in RBC, HCT, HGB, PT, APTT and FIB between the 2 groups before operation(P>0.05). RBC, HCT and HGB in the tranexamic acid group were significantly higher than those in the control group at postoperative 1 h and 72 h, and the differences were statistically significant(P<0.05). The total blood loss, overt blood loss, occult blood loss and blood transfusion in the tranexamic acid group were lower than those in the control group, and the differences were statistically significan(t P<0.05). Conclusion Perioperative use of tranexamic acid has a positive effect on blood management of elderly patients with LSS. It can reduce the total perioperative blood loss, overt blood loss, occult blood loss and blood transfusion during perioperative period.