氨甲环酸联合控制性降压对脊柱手术出血的影响

杨惠鸿; 闫磊; 徐桂萍

doi:10.16766/j.cnki.issn.1674-4152.002489

氨甲环酸联合控制性降压对脊柱手术出血的影响

doi: 10.16766/j.cnki.issn.1674-4152.002489

新疆维吾尔自治区人民医院麻醉科，新疆乌鲁木齐 830001

基金项目:

新疆维吾尔自治区自然科学基金项目 2017D01C137

详细信息

通讯作者:
闫磊, E-mail: nmyanlei@yeah.net

中图分类号: R681.5R614.24
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出版历程
- 收稿日期: 2021-06-15
- 网络出版日期: 2022-09-21

Effects of tranexamic acid and controlled hypotension on hemorrhage in spinal surgery

Department of Anesthesiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830001, China

摘要

摘要: 目的探究氨甲环酸联合控制性降压对脊柱手术出血的影响。方法选择2019年1月—2020年2月新疆维吾尔自治区人民医院择期脊柱手术患者120例，采用随机数字表法随机分为3组：对照组(S组)、氨甲环酸组(TXA组)、氨甲环酸联合控制性降压组(TXA+CH组)，各40例。S组切皮即刻静脉注射生理盐水0.2 mL/kg，术中以0.1 mL/(kg·h)的速率泵注至术毕。TXA组注射氨甲环酸20 mg/kg，术中以10 mg/(kg·h)的速率泵注至术毕。TXA+CH组在TXA组基础上，泵注硝普钠行控制性降压至主要手术完成。记录术前、术后1 d的各项指标及术后1周不良事件发生情况等。结果与S组相比，TXA组和TXA+CH组术中出血量[(434.2±73.4) mL vs. (287.6±73.6) mL vs. (236.2±59.4) mL]、术后24小时引流量[110.0(91.3, 145.0) mL vs. 77.5(60.0, 95.0) mL vs. 60.0(50.0, 70.0) mL]、术中视野质量评分[(3.3±0.5)分vs. (2.4±0.5)分vs. (2.2±0.4)分]、住院时间[8.5(7.0, 15.0) d vs.6.5(5.0, 9.0) d vs. 6.0(5.0, 7.8) d]差异均有统计学意义(均P＜0.05)；与TXA组相比，TXA+CH组术中出血量和手术视野质量评分降低(均P＜0.05)，术后24小时引流量和住院时间比较差异无统计学意义(均P＞0.05)。3组患者术前各生化指标比较差异均无统计学意义(均P＞0.05)；术后1 d 3组患者RBC、Hb、HCT差异有统计学意义(均P < 0.05)。3组患者均未发生不良反应。结论氨甲环酸可以减少脊柱手术出血量，而且联合控制性降压的效果更佳。
- 氨甲环酸 /
- 控制性降压 /
- 脊柱手术 /
- 血液保护
Abstract: Objective To investigate the effect of tranexamic acid combined with controlled hypotension on perioperative bleeding after spinal surgery. Methods A total of 120 spinal surgery patients in the People ' s Hospital of Xinjiang Uygur Autonomous Region from January 2019 to February 2020 were selected and divided into 3 groups by random number table method: S group, TXA group and TXA + CH group. In S group, 0.2 mL/kg of normal saline was intravenously injected immediately after anesthesia induction, and was pumped at a rate of 0.1 mL/(kg·h) until the end of surgery. TXA group was injected with tranexamic acid 20 mg/kg at a rate of 10 mg/(kg·h) by intravenous pump until the end of operation. In the TXA+CH group, on the basis of the TXA group, sodium nitroprusside was pumped for controlled blood pressure until the main operation was completed. The indicators before and 1 day after operation and the occurrence of adverse events in one week after operation were recorded. Results Compared with S group, intraoperative blood loss in TXA group and TXA+CH group [(434.2±73.4) mL vs. (287.6±73.6) mL vs. (236.2±59.4) mL], postoperative drainage volume [110.0 (91.3, 145.0) mL vs. 77.5 (60.0, 95.0) mL vs. 60.0 (50.0, 70.0) mL], intraoperative visual field quality score [(3.3±0.5) points vs. (2.4±0.5) points vs. (2.2±0.4) points], days of hospitalization [8.5 (7.0, 15.0) d vs. 6.5 (5.0, 9.0) d vs. 6.0 (5.0, 7.8) d], the differences were statistically significant (all P < 0.05). Compared with TXA group, intraoperative blood loss and SSFQ score of TXA+CH group were decreased (all P < 0.05), and there was no significant difference in the length of hospital stay and 24-hour postoperative drainage volume (all P>0.05). There was no statistical significance in the biochemical indexes between the three groups before operation (all P>0.05). There were differences in RBC, HB, and HCT among the three groups at 1 d after operation (all P < 0.05). There were no adverse reactions in the three groups of patients. Conclusion Tranexamic acid can reduce blood loss in patients undergoing spinal surgery, and tranexamic acid combined with controlled hypotension has the best effect on reducing blood loss.
- Tranexamic acid /
- Controlled hypotension /
- Spine surgery /
- Blood conservation

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表 1 3组脊柱手术患者一般情况各指标和手术时间比较(x±s)

Table 1. The general conditions and operation time of the three groups were compared(x±s)

组别	例数	年龄(岁)	BMI	手术时间(min)	输液量(mL)	尿量(mL)
S组	40	56.8±6.6	24.6±3.3	170.5±21.1	2 020.5±313.7	398.3±100.8
TXA组	40	57.2±6.0	24.9±2.6	176.5±23.7	1 990.0±291.6	402.0±99.7
TXA+CH组	40	55.5±6.0	24.4±2.4	179.8±16.0	2 040.0±209.8	422.3±117.9
F值		0.822	0.336	2.113	1.131	0.588
P值		0.442	0.715	0.125	0.326	0.557

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表 2 3组脊柱手术患者手术情况各指标比较

Table 2. The indexes of spinal surgery were compared among the three groups

组别	例数	术中出血量(x±s，mL)	术后24小时引流量[M(P₂₅, P₇₅)，mL]
S组	40	434.2±73.4	110.0(91.3, 145.0)
TXA组	40	287.6±73.6^a	77.5(60.0, 95.0)^a
TXA+CH组	40	236.2±59.4^ab	60.0(50.0, 70.0)^a
统计量		88.445^c	46.928^d
P值		< 0.001	< 0.001
注：与S组比较，^aP < 0.05；与TXA组比较，^bP < 0.05；^c为F值，^d为χ²值。

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表 3 3组脊柱手术患者SSFQ评分和术后住院时间比较

Table 3. Comparison of SSFQ scores and postoperative hospital stay among the three groups of spinal surgery patients

组别	例数	SSFQ评分(x±s，分)	术后住院时间[M(P₂₅, P₇₅)，d]
S组	40	3.3±0.5	8.5(7.0, 15.0)
TXA组	40	2.4±0.5^a	6.5(5.0, 9.0)^a
TXA+CH组	40	2.2±0.4^ab	6.0(5.0, 7.8)^a
统计量		67.797^c	14.527^d
P值		< 0.001	< 0.001
注：与S组比较，^aP < 0.05；与TXA组比较，^bP < 0.05；^c为F值，^d为χ²值。

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表 4 3组脊柱手术患者各项生化指标比较

Table 4. Comparison of biochemical indexes among three groups of patients undergoing spinal surgery

组别	例数	RBC(x±s，×10⁹/L)		Hb(x±s，g/L)		HCT(x±s，%)		ALT[M(P₂₅, P₇₅)，U/L]
组别	例数	T1	T2	T1	T2	T1	T2	T1	T2
S组	40	4.5±0.5	3.8±0.5	136.4±14.3	115.4±12.9	40.8±3.9	34.1±3.1	16.2(13.9, 20.2)	19.5(16.0, 28.8)
TXA组	40	4.5±0.4	4.1±0.4^b	139.2±12.7	127.6±13.9^b	41.1±3.4	37.2±3.8^b	19.6(15.5, 27.0)	23.0(16.4, 28.8)
TXA+CH组	40	4.6±0.6	4.3±0.5^b	141.8±15.6	133.0±14.6^b	42.2±4.8	38.3±3.8^b	21.6(14.0, 28.8)	27.0(18.3, 32.0)
统计量		0.311^a	15.201^a	1.461^a	17.124^a	1.269^a	14.595^a	3.565^c	2.544^c
P值		0.734	< 0.001	0.236	< 0.001	0.285	< 0.001	0.168	0.280

组别	例数	AST(x±s，U/L)		BUN(x±s，mmol/L)		Cr(x±s，μmol/L)		PT(x±s，s)
组别	例数	T1	T2	T1	T2	T1	T2	T1	T2
S组	40	19.0±9.6	22.6±6.8	5.3±2.1	5.1±1.9	59.7±14.3	60.5±13.6	11.5±1.0	14.0±1.9
TXA组	40	19.3±5.1	24.1±7.6	4.6±1.9	5.0±1.5	61.4±11.3	62.2±16.4	11.4±1.3	13.5±1.3
TXA+CH组	40	18.0±4.6	21.7±7.4	4.8±1.4	4.7±1.1	57.9±10.0	56.8±9.8	11.5±1.0	13.5±1.3
统计量		0.381^a	1.055^a	1.496^a	0.886^a	0.866^a	1.667^a	0.127^a	1.485^a
P值		0.684	0.351	0.228	0.415	0.423	0.193	0.881	0.231

组别	例数	TT(x±s，s)		APTT(x±s，s)		D-二聚体[M(P₂₅, P₇₅)，μg/L]		FIB(x±s，g/L)
组别	例数	T1	T2	T1	T2	T1	T2	T1	T2
S组	40	18.4±1.6	20.2±1.6	29.4±4.0	33.5±4.2	0.6(0.3, 0.7)	0.7(0.4, 1.2)	2.8±0.9	3.1±0.9
TXA组	40	18.4±1.5	20.2±1.4	29.0±3.2	32.8±3.7	0.4(0.2, 0.7)	0.5(0.3, 0.7)	2.6±0.5	2.9±0.7
TXA+CH组	40	18.0±1.3	20.0±1.5	28.0±1.9	32.6±4.1	0.4(0.3, 0.7)	0.7(0.4, 0.8)	2.9±1.1	3.1±0.7
统计量		1.743^a	0.934^a	2.029^a	0.574^a	2.649^c	5.694^c	1.602^a	0.998^a
P值		0.179	0.396	0.136	0.565	0.266	0.058	0.206	0.372
注：^a为F值；与S组比较，^bP < 0.05；^c为χ²值。

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