氨甲环酸对多节段腰椎内固定术围手术期失血量控制及安全性的影响

摘要

目的:探讨氨甲环酸(TXA)对减少多节段腰椎内固定术围手术期失血量的有效性和安全性.方法:选择2014年1月至2016年1月广东医科大学附属佛山禅城中心医院收治的全麻下行多节段(≥2节段)腰椎内固定手术患者200例,随机分为研究组和对照组,每组100例.研究组手术过程中给予TXA静脉滴注,对照组给予等体积生理盐水.对比两组患者术后失血量、引流量、血红蛋白(Hb)以及血细胞比容(Het)的变化,术中、术后输血率以及术后血栓、感染等并发症的发生率.结果:研究组总失血量、术中失血量、术后引流量及术中、术后输血率均较对照组低(均P ＜0.05);研究组在术后12 h、48 h Hb以及Hct值均高于对照组(均P＜0.05).两组患者在血栓、感染等并发症发生率比较,差异均无统计学意义(均P＞0.05).结论:TXA可有效降低多节段腰椎内固定术围手术期总失血量与输血率,且不增加血栓事件的发生风险,值得临床推广应用.%Objective:To compare the efficacy and safety of tranexamic acid(TXA) on blood-loss control in patients undergoing multilevel lumbar interbody fusion.Methods:200 patients undergoing multilevel lumbar interbody fusion in our hospital from January 2014 to January 2016 were selected and randomized into a study group(n =100) and a control group(n =100).The patients in the study group received TXA via intravenous injection,and those in the control group received equal volume of saline.Postoperative blood-loss volume,drainage volume,hemoglobin(Hb) level,hematocrit(Hct),blood transfusion rate,and the incidence of infection and deep venous thrombosis were recorded and compared.Results:Compared with the control group,the total blood-loss volume,drainage volume and the rate of blood transfusion were reduced,while the Hb level and Hct at 12 h and 48 h after surgery were elevated in the study group(P＜0.05).There was no significant difference in the incidence of thrombosis and infection between the two groups (P ＞0.05).Conclusion:Intravenous administration of TXA could effectively reduce blood-loss volume and transfusion required in multilevel lumbar interbody fusion,and did not increase the risk of deep venous thrombosis.