摘要
目的观察氨甲环酸局部应用对腰椎手术患者切口引流量及凝血功能的影响。方法收集2016年1月-2017年12月接受腰椎后路开放手术的患者90例,随机分成2组,试验组46例在手术切口关闭之前采用含氨甲环酸1.0 g(用100 mL生理盐水稀释)的混合液浸泡切口,对照组44例切口给予相应体积的生理盐水浸泡。分别记录2组术后切口引流量、输血例数及输血量。术后第1、3、5天测定患者血红蛋白水平,术前3 h和术后3 h测定纤维蛋白原水平、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体。术后5~7 d行双下肢彩色多普勒超声检查,观察双下肢深静脉血栓(DVT)形成情况。结果试验组术后6 h和48 h引流量分别为(25.8±12.2)mL和(18.5±9.6)mL,明显少于对照组的(166.2±95.4)mL和(75.6±45.8)mL,差异均有统计学意义(P<0.05)。试验组和对照组患者输血例数分别为5例和7例,差异无统计学意义(P>0.05);试验组输血量为(1.3±0.4)U,少于对照组的(2.4±0.6)U,差异有统计学意义(P<0.05);试验组未输血患者术后第1、3、5天血红蛋白水平高于对照组,差异无统计学意义(P<0.05)。2组患者术前3 h和术后3 h纤维蛋白原、PT、APTT、D-二聚体值差异无统计学意义(P>0.05)。术后5~7 d,2组患者均未见DVT形成。结论局部应用氨甲环酸可减少腰椎手术后切口引流量和输血量,但不增加静脉血栓形成的风险。
Objective To observe the effect of local application of tranexamic acid in lumbar spine surgery on postoperative drainage volume and coagulation function.Methods Ninety patients who received lumbar spine surgery from January 2016 to December 2017 were enrolled and randomly divided into 2 groups.Patients in experimental group(n=46)were treated with a mixture of 100 mL saline and 1.0 g tranexamic acid to immerse the incision before closing the incision.And patients in control group(n=44)were given the same volume of normal saline to immerse the incision.The postoperative drainage volume,the number of patients with blood transfusion and blood transfusion volume were recorded.The hemoglobin at 1,3,5 d after operation,and fibrinogen,prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer at preoperative and postoperative 3 h were detected.The incidence rate of deep vein thrombosis(DVT)of the lower limbs at 5-7 d after operation was determined by color Doppler ultrasonography.Results The postoperative drainage volumes of experimental group[(25.8±12.2)mL and(18.5±9.6)mL]were lower than those of control group[(166.2±95.4)mL and(75.6±45.8)mL]at 6 h and 48 h after operation,with a statistical significance(P<0.05).There was no statistical difference in the number of patients with blood transfusion between 2 groups(5 cases in experimental group and 7 in control group,P>0.05),however,the blood transfusion volume of experimental group[(1.3±0.4)U]was lower than that of control group[(2.4±0.6)U],with a statistical significance(P<0.05).The levels of hemoglobin in patients without blood transfusion in experimental group were significantly higher than those of control group at 1,3,5 d after operation(P<0.05).There were no statistical differences in fibrinogen,PT,APTT,D-dimer at preoperative and postoperative 3 h and the incidence rate of DVT of the lower limbs at 5-7 d between the 2 groups(P>0.05).Conclusion The local application of tranexamic acid in lumbar spine surgery could significantly reduce the postop
作者
夏炳江
沈兴潮
韦金忠
凌义龙
XIA Bing-jiang;SHEN Xing-chao;WEI Jin-zhong;LING Yi-long(Department of Orthopaedics,Shaoxing Hospital of Traditional Chinese Medicine,Shaoxing 312000,Zhejiang,China)
出处
《脊柱外科杂志》
2020年第3期168-171,192,共5页
Journal of Spinal Surgery
基金
浙江省自然科学基金(LQ18H270006)
浙江省中医药科技计划项目(2017ZB091)。
关键词
腰椎
氨甲环酸
出血
手术
手术后并发症
静脉血栓形成
Lumbar vertebrae
Tranexamic acid
Blood loss,surgical
Postoperative complications
Venous thrombosis
