大剂量氨甲环酸降低脊柱结核患者围手术期出血风险

目的探讨预防性应用大剂量氨甲环酸能否有效减少脊柱结核围手术期出血及相关不良事件。方法选择本院2016年1月-2018年12月行一期经椎间孔入路病灶切除椎间植骨融合内固定术治疗的腰椎结核患者90例,随机分为小剂量氨甲环酸治疗组(小剂量组)、大剂量氨甲环酸治疗组(大剂量组)和对照组,每组30例。所有患者全身抗结核治疗2~3周后行一期经椎间孔入路病灶切除椎间植骨融合内固定治疗。小剂量组静脉泵注含1 mg/kg氨甲环酸的生理盐水50 mL,大剂量组泵注含15 mg/kg氨甲环酸的生理盐水50 mL,对照组泵注等量生理盐水,均于术前30 min开始泵注。记录手术时间,术中和术后出血时间、出血量、输血量,手术前后凝血功能,术后引流量、血红蛋白量及红细胞比容,住院时间、术后恢复时间及其他不良事件。结果3组患者手术时间、术中及术后出血时间、术后出血量及输血量、手术前后凝血功能、住院时间、术后恢复时间差异均无统计学意义(P>0.05)。大剂量组术中出血量及输血量和术后引流量均较小剂量组和对照组降低,差异有统计学意义(P<0.05),小剂量组与对照组差异无统计学意义(P>0.05)。大剂量组术后血红蛋白水平、术后红细胞比容均高于小剂量组及对照组,差异有统计学意义(P<0.05),小剂量组与对照组之间差异无统计学意义(P>0.05)。所有患者围手术期均未发生手术部位感染、血管和神经损伤及静脉血栓等严重并发症。所有患者术后随访8~12个月,椎间植骨均获得骨性融合,未发生假关节形成,内固定物断裂、松动、脱落等情况。所有患者结核症状消失,病灶全部愈合,无复发。结论术前预防性应用大剂量氨甲环酸可降低脊柱结核患者围手术期出血风险,且不增加不良事件发生风险。

High dose tranexamic acid reduces risk of perioperative bleeding in spinal tuberculosis

Objective To investigate the effects of high dose tranexamic acid(TXA) on bleeding and complications in spinal tuberculosis surgery. Methods From January 2016 to December 2018,90 patients with lumbar tuberculosis receiving one-stage transforaminal discectomy,interbody fusion,internal fixation and bone grafting were enrolled in the study,and were divided into 3 groups(n=30):low dose of TXA group(low dose group),high dose TXA group(high dose group) and control group. All the patients received 2-3 weeks of general antituberculosis treatment,and were treated with one-stage transforaminal discectomy,interbody fusion,internal fixation and bone grafting. Patients in low-dose group were intravenously pumped with 50 mL of normal saline containing 1 mg TXA;patients in high-dose group were intravenously pumped with 50 mL of normal saline containing tranexamic acid 15 mg TXA;while control group received intravenous pumping of the same amount of saline. All the patients were pumped from 30 min before operation. The operation time,intraoperative and postoperative bleeding time,intraoperative and postoperative blood loss,intraoperative and postoperative blood transfusion,preoperative and postoperative coagulation function,postoperative drainage,postoperative hemoglobin and hematocrit,hospital stay,postoperative recovery and complications were calculated and compared between the 3 groups. Results There were no statistically significant differences between the 3 groups in operation time,intraoperative and postoperative bleeding time,postoperative blood loss and blood transfusion,preoperative and postoperative coagulation function,hospital stay and postoperative recovery(P>0.05). However,in the high dose group,intraoperative blood loss,intraoperative blood transfusion and postoperative drainage were significantly lower than those in the other 2 groups(P<0.05),while there was no significant difference between the low dose group and control group(P>0.05). The hemoglobin level and hematocrit of the high dose group were higher than those of the low dose group and control group,the difference was statistically significant(P<0.05),and there was no significant difference between the low dose group and control group(P>0.05). All the patients had no surgical site infection,or serious complications such as vascular and nerve injury or venous thrombosis. All the patients were followed up for 8 -12 months,and bone fusion was achieved. No pseudarthrosis,fracture,loosening and falling off of internal fixator occurred. All the tuberculosis symptoms disappeared and all the lesions healed without recurrence. Conclusion High dose TXA can significantly reduce the risk of perioperative bleeding in spinal tuberculosis,and does not increase the risk of adverse events.