摘要
目的探讨颈椎后路椎管扩大成形术切口内应用氨甲环酸注射液对减少术后出血有效性及其应用的安全性。方法对2013年1月—2015年1月间初次进行颈椎后路椎管扩大成形术的64例患者进行前瞻性研究,将患者随机分为应用组(A组,32例)和对照组(B组,32例)。在手术缝合深筋膜后,吸引器抽吸引流管后夹闭,向A组患者切口内注射氨甲环酸10 ml(1 g),B组向切口内注射生理盐水10 ml作为对照,夹闭引流管1 h后开放。比较两组患者术前血液学指标、术中失血量、术后24 h引流量及总引流量、术后第3天血红蛋白量及白蛋白下降量、术后血D-二聚体浓度、术后输血例数及输血量,术后2 w内发生双下肢深静脉血栓形成情况。结果术后24 h内引流量A组患者为(128±50)ml,B组患者为(230±73)ml,两组间有统计学差异(P<0.05);术后总引流量A组患者为(205±65)ml,B组患者为(326±102)ml,两组间有统计学差异(P<0.05);术后第3天血红蛋白浓度A组患者为(128.9±15.0)g/L,B组患者为(104.2±12.2)g/L,两组间有统计学差异(P<0.05);术后第3天白蛋白下降量A组患者为(3±2)g/L,B组患者为(8±4)g/L,两组间有统计学差异(P<0.05);A组术后输血4例,B组术后输血9例,两组间具有统计学差异(P<0.05)。术后A组患者平均输血(270±30)ml;B组患者平均输血(540±135)ml,两组患者术后输血量有明显统计学差异(P<0.05)。术后血D-二聚体浓度无显著性差异(P>0.05),术后2周时彩超检查两组患者均未发现有下肢深静脉血栓形成。结论颈椎后路椎管扩大成形术切口内局部应用氨甲环酸注射液可减少术后切口失血量、减少白蛋白丢失、不增加深静脉血栓形成的风险,减少了术后输血。
Objective To explore the safety and effectiveness of local injection of tranexamic acid at postoperation of cervical vertebral canal plasty. Methods The 64 patients who underwent cervical vertebral canal plasty for the first time from January 2013 to January 2015 were enrolled in this prospective study. The patients were randomly divided into an application group （group A,n=32） and control group （group B,n=32）. Tranexamic acid （10 ml） was injected into the cervical vertebral canal plasty wounds after the deep fascia was closed in group A,and saline （10 ml） was injected into the cervical vertebral canal plasty wounds of group B. The drain pipes were clamped for 1 h. The hematologic data,volume of blood loss and intraoperative transfusion,duration of drainage,volume ofthe first 24 h drainage and general drainage,on the 3rd day after operation hemoglobin level and albumin loss,postoperative D-dimer level,the number of patients receiving blood transfusions,and the volume of blood transfusion were compared between the two groups at 2 weeks after operation. Results The drainage volume within 24 hours after surgery in group A was （128±50）ml,in group Bwas （230±73）ml,and there was a statistically significant difference（P〈0.05）. The volume of total drainage after surgery in group A was（205±65）ml, in group B was（326±102）ml,and there was a statistically significant difference（P〈0.05）. There was a statistically significant difference on the 3rd day after surgery hemoglobin level of between the two groups with（128.9±15.0） g/ L for group A and（104.2±12.2）g/L for group B,also the albumin loss with（3±2）g/L for group A and（8±4）g/L for group B （P〈0.05）;4 patients in group A and 9 patients in group B received blood transfusion therapy,and it was of a statistical difference（P〈0.05）. The volume of postoperative blood transfusion was （270±30） ml in group A and （540±135） ml in group B,which had a statistical difference（P〈0.05）. No deep venous thrombosis was found at the 2-week after operation by using follow-up color ultrasound examination. Conclusion Local injection of tranexamic acid at postoperation of cervical vertebral canal plasty may reduce postoperative blood loss and the volume and albumin loss. Moreover,the risk of nerve root compression due to hematoma and the formation of deep venous thrombosis may not be increased after local injection of tranexamic acid.
出处
《实用医药杂志》
2017年第4期309-311,共3页
Practical Journal of Medicine & Pharmacy
基金
河南省教育厅高校重点科研项目(16A320076)
关键词
氨甲环酸
颈椎后路椎管扩大成形术
术后失血
Tranexamic acid
Posterior cervical vertebral canal plasty
Postoperative blood loss
作者简介
[通讯作者]吴广良，Email：wuguangliang@sina．com
