氨甲环酸对胸腰椎骨折脱位围手术期失血的影响△

Effect of tranexamic acid on perioperative blood loss of thoracolumbar fracture and dislocation

摘要:

[目的]探讨氨甲环酸(tranexamicacid, TXA)减少胸腰椎骨折脱位围术期失血中的作用。[方法]回顾性分析 2013 年 1 月—2021 年 6 月本院手术治疗胸腰椎骨折脱位 63 例患者的临床资料，其中 TXA 组 33 例，非 TXA 组 30 例。比较两组患者围术期和血液学检验资料。[结果]TXA 组手术时间、术中出血量、术后 24 h 引流量显著优于非 TXA 组(P＜0.05)。术后第 3 d 常规行双侧下肢血管超声检查，均未见深静脉血栓形成。与术前相比，两组患者术后第 1 d Hb、Hct、PLT 均显著减少(P＜ 0.05)，PT 显著增加 (P＜0.05)，而 APTT 的差异无统计学意义 (P＞0.05)。术前两组上述检验指标的差异均无统计学意义 (P＞ 0.05)；术后第 1 d，TXT 组 Hb、Hct、PLT 水平均显著高于非 TXA 组 (P＜0.05)，但两组 PT 和 APTT 差异无统计学意义 (P＞ 0.05)。[结论]术前静脉应用氨甲环酸可以有效减少胸腰椎骨折脱位围术期出血量，疗效安全可靠。

Abstract:

[Objective] To investigate the effect of tranexamic acid (TXA) on perioperative blood loss of thoracolumbar fracture and dis- location. [Methods] A retrospective study was performed on 63 patients who underwent surgical treatment for thoracolumbar fracture and dislocation in our hospital from January 2013 to June 2021, including 33 patients in the TXA group and 30 patients in the non-TXA group. The perioperative and blood test data of the two groups were compared. [Results] The TXA group proved significantly superior to the nonTXA group in terms of operation time, intraoperative blood loss and drainage 24 hours after operation (P＜0.05) . On the third day after oper- ation, no deep vein thrombosis was found by ultrasound in anyone of both groups. Compared with those preoperatively, the Hb, Hct and PLT significantly decreased (P＜0.05) , while the PT significantly increased (P＜0.05) , and APTT remained unchanged significantly 1 day postop- eratively in both groups (P＞0.05) . Although there was no significant difference in the above blood test parameters between the two groups before operation (P＞0.05) , the TXA group had significantly higher Hb, Hct and PLT than the non-TXA group 1 day postoperatively (P＜ 0.05) , whereas there was no significant difference in PT and APTT between the two groups (P＞0.05) . [Conclusion] Preoperative intrave- nous tranexamic acid does effectively reduce perioperative blood loss of thoracolumbar fracture and dislocation, which is safe and reliable.