2020 年第 1 期 第 15 卷

氨甲环酸减少脊柱手术出血量的有效性及安全性

Efficacy and safety of tranexamic acid in reducing blood loss in spinal surgery

作者：闫磊1杨惠鸿2何虹3徐桂萍1

英文作者：

单位：1新疆维吾尔自治区人民医院麻醉科，乌鲁木齐830001；2新疆维吾尔自治区石河子大学医学院2018级麻醉学专业硕士研究生832000；3新疆维吾尔自治区石河子大学医学院2017级麻醉学专业硕士研究生832000

英文单位：

关键词：脊柱手术；氨甲环酸；出血量

英文关键词：

• 摘要：

• 【摘要】目的    探究氨甲环酸减少脊柱手术患者出血量的有效性和安全性。方法    选择2018年 9月至2019年1月新疆维吾尔自治区人民医院于全身麻醉下实施脊柱择期手术患者40例，采用随机数字表法分为氨甲环酸组和对照组，各20例。氨甲环酸组麻醉诱导后切皮即刻静脉注射氨甲环酸15 mg/kg，术中以10 mg/（kg·h）的速率静脉泵注至术毕。对照组同时点静脉注射等量0.9%氯化钠注射液。比较2组患者手术相关资料和术前及术后1 d生化指标。记录2组术后1周内不良反应发生情况。结果    2组患者手术时间、输液量、尿量比较，差异均无统计学意义（均P＞0.05）。氨甲环酸组术中出血量、术后24 h引流量、总失血量、术后住院时间和手术视野质量评分均明显低于对照组［（201±105）ml比（413±112）ml、（82±61）ml比（118±45）ml、（283±144）ml比（525±120）ml、（8±4）d比（12±6）d、（2.30±0.47）分比（3.05±0.22）分］，差异均有统计学意义（均P＜0.05）。术前，2组生化指标比较，差异均无统计学意义（均P＞0.05）。术后1 d，氨甲环酸组红细胞计数、血红蛋白、血细胞比容均明显高于对照组［（4.2±0.4）×109/L比（3.8±0.5）×109/L、（127±15）g/L比（115±13）g/L、（37±4）%比（34±3）%］，差异均有统计学意义（均P＜0.05)，2组其余生化指标比较，差异均无统计学意义（均P＞0.05)。2组患者术后1周内均未发生深静脉血栓、肺栓塞、过敏反应、癫、头疼、恶心呕吐等不良反应。结论    术中应用氨甲环酸可明显减少脊柱手术患者术中出血量和术后24 h引流量，缩短患者术后住院时间，安全有效。

• 【Abstract】Objective    To explore the efficacy and safety of tranexamic acid(TXA) in reducing blood loss in patients undergoing spinal surgery. Methods    Forty patients undergoing elective spinal surgery with general anesthesia in People′s Hospital of Xinjiang Uygur Autonomous Region were randomly divided into TXA group and control group, with 20 cases in each group. The TXA group had intravenous injection of TXA 15 mg/kg during skin incision and continuous administration at a rate of 10 mg/(kg·h) during operation. The control group was given equal volume of 0.9% sodium chloride. Surgical data, relevant biochemical indexes before and 1 d after operation, and the incidence of adverse reactions within 1 week after operation were analyzed. Results    There were no significant differences in operation time, infusion volume and urine volume between groups(all P＞0.05). Intraoperative blood loss, 24 h drainage, total blood loss, postoperative hospitalization time and visual field quality score in the TXA group were significantly less than those in the control group［（201±105）ml vs （413±112）ml, （82±61）ml vs （118±45）ml, （283±144）ml vs （525±120）ml, （8±4）d vs （12±6）d, （2.30±0.47） vs （3.05±0.22）］（all P＜0.05）. Before operation, there were no significant differences in biochemical indexes between groups(P＞0.05). On the 1st day after operation, erythrocyte count, hemoglobin and hematocrit in the TXA group were significantly higher than those in the control group［（4.2±0.4）×109/L vs （3.8±0.5）×109/L, （127±15）g/L vs （115±13）g/L, （37±4）% vs （34±3）%］（all P＜0.05); no significant difference was noticed in the rest biochemical indexes(all P>0.05). No adverse reactions such as deep vein thrombosis, pulmonary embolism, allergic reaction, epilepsy, headache, nausea and vomiting were observed within 1 week after operation. Conclusion    Intraoperative use of TXA can effectively and safely reduce blood loss and postoperative 24 h drainage, and shorten postoperative hospitalization in patients with spine surgery.