氨甲环酸静脉及局部应用在腰椎结核围手术期中的效果评价

doi:10.19982/j.issn.1000-6621.20220037

摘要/Abstract

摘要：

目的: 探讨氨甲环酸静脉及局部应用在腰椎结核围手术期中的临床价值。 方法: 采用前瞻性研究的方法,搜集2019年1月至2022年1月青岛市胸科医院收治的腰椎结核患者92例,随机分为观察组(46例)和对照组(46例),观察组术前静脉滴注氨甲环酸0.5g(5ml),术后12h内给药1次,每次0.5g,术中每腔内喷洒氨甲环酸 0.5g(包括腰椎后路小切口、腰椎斜前方切口及髂骨取骨区切口)。对照组术前静脉滴注氨甲环酸0.5g,术后12h内静脉给药1次,每次0.5g。两组均进行腰椎斜前方入路病椎清除植髂骨融合手术,比较两组术中出血量、手术时间、术后24h引流量、术后72h引流量,术后3d红细胞比容,术后3d血红蛋白下降值,术后1周血D-二聚体(D-D)水平、凝血功能(凝血酶原时间、活化部分凝血活酶时间)等相关指标。 结果: 92例患者均顺利完成手术,术后经下肢静脉彩色超声检查,均无深静脉血栓形成。观察组手术时间[(149.0±23.8)min]、术中出血量[(344.0±120.0)ml]与对照组[分别为(145.0±26.3)min和(360.0±134.0)ml)]相比,差异均无统计学意义(t=0.765,P=0.443; t=0.603,P=0.402)。观察组术后24h引流量、术后72h引流量、术后3d血红蛋白下降值分别为(64.0±23.3)ml、(159.0±25.2)ml、(28.2±8.1)g/L,均低于对照组[分别为(77.0±33.1)ml、(174.0±27.2)ml、(32.5±9.6)g/L)],差异均有统计学意义(t=2.178,P=0.042;t=2.743,P=0.032;t=2.324,P=0.037)。观察组术后3d红细胞比容为(32.1±8.3)%,高于对照组[(28.2±10.2)%],差异有统计学意义(t=2.014,P=0.048)。观察组胃肠道反应发生率、术后3d凝血酶原时间、活化部分凝血酶原时间、术后1周血D-D水平分别为8.7%(4/46)、(13.1±3.2)s、(36.1±6.1)s、(0.9±0.2)mg/L,对照组分别为10.9%(5/46)、(12.6±2.9)s、(34.6±5.6)s、(0.9±0.3)mg/L,差异均无统计学意义(χ²=0.123,P=0.212;t=0.835,P=0.517;t=1.229,P=0.224;t=0.366,P=0.712)。 结论: 静脉及局部应用氨甲环酸能有效减少腰椎结核病灶清除植骨内固定手术的渗血量,明显减少术后的出血量,不增加术后血栓形成风险,可使患者达到快速康复的目的。

关键词: 腰椎, 结核, 氨甲环酸, 外科手术,微创性, 康复

Abstract:

Objective: To investigate the clinical value of intravenous and local application of tranexamic acid (TXA) in perioperative period of lumbar tuberculosis. Methods: A total of 92 lumbar tuberculosis patients admitted to Qingdao Chest Hospital from January 2019 to January 2022 were prospectively analyzed. They were randomly divided into observation group (n=46) and control group (n=46). In the observation group, 0.5 g (5 ml) TXA was injected intravenously before operation, and 0.5 g of TXA was given once within 12 hours after operation. During the operation, 0.5 g of TXA was sprayed in each cavity (including small incision of lumbar posterior approach, oblique anterior incision of lumbar spine and incision of iliac bone extraction area). In the control group, 0.5 g TXA was injected intravenously before operation, and 0.5 g was given intravenously before surgery and 0.5 g intravenously within 12 hours after surgery. Patients in both groups underwent lumbar obliquely anterior approach diseased vertebra removal and iliac bone grafting fusion. The intraoperative bleeding volume, operation duration, drainage volume 24 hours and 72 hours after operation, hematocrit 3 days after operation, hemoglobin decrease 3 days after surgery, blood D-dimer (D-D) level 1 week after surgery, coagulation function (prothrombin time, activated partial thrombin time) and other related indicators were compared between the two groups. Results: All the 92 patients successfully completed the operation and no deep vein thrombosis was found by color Doppler ultrasonography of lower extremity veins. There was no significant difference in operation duration and intraoperative bleeding between the two groups ((149.0±23.8) min vs. (145.0±26.3) min, t=0.765, P=0.443; (344.0±120.0) ml vs. (360.0±134.0) ml, t=0.603,P=0.402). The drainage volume 24 hours and 72 hours after operation, and the decrease of hemoglobin 3 days after operation in the observation group were significantly lower than those in the control group ((64.0±23.3) ml vs. (77.0±33.1) ml, t=2.178, P=0.042; (159.0±25.2) ml vs. (174.0±27.2) ml, t=2.743, P=0.032; (28.2±8.1)g/L vs. (32.5±9.6)g/L, t=2.324, P=0.037, respectively). The erythrocyte specific volume in the observation group [(32.1±8.3) %] was higher than that in the control group ((28.2±10.2) %), the difference was statistically significant (t=2.014, P=0.048). There was no significant difference in the incidence of gastrointestinal reactions, prothrombin time 3 days after surgery, activated partial prothrombin time and blood D-D level 1 week after surgery between the two groups (8.7% (4/46) vs. 10.9% (5/46), χ²=0.123, P=0.212; (13.1±3.2) s vs. (12.6±2.9) s, t=0.835, P=0.517; (36.1±6.1) s vs. (34.6±5.6) s, t=1.229, P=0.224; (0.9±0.2) mg/L vs. (0.9±0.3) mg/L, t=0.366, P=0.712, respectively). Conclusion: Intravenous and local application of TXA could effectively reduce the blooding volume in the operation of lumbar tuberculosis, reduce the amount of blooding after surgery, and not increase the risk of postoperative thrombosis, so that patients could achieve the goal of rapid rehabilitation.

Key words: Lumbar vertebrae, Tuberculosis, Tranexamic acid, Surgical procedures,minimally invasive, Rehabilitation

中图分类号:

R529.2
R61

周伟东, 刘洁清, 刘朝阳, 赵明伟. 氨甲环酸静脉及局部应用在腰椎结核围手术期中的效果评价[J]. 中国防痨杂志, 2022, 44(6): 565-569. doi: 10.19982/j.issn.1000-6621.20220037

ZHOU Wei-dong, LIU Jie-qing, LIU Zhao-yang, ZHAO Ming-wei. Effect evaluation of intravenous and local application of tranexamic acid in perioperative period of lumbar tuberculosis[J]. Chinese Journal of Antituberculosis, 2022, 44(6): 565-569. doi: 10.19982/j.issn.1000-6621.20220037

图/表 2

表1

两组患者的一般资料

特征	观察组(46例)	对照组(46例)	统计检验值	P值
性别 [例(构成比,%)]			χ²=0.192	0.672
男性	31(67.4)	29(63.0)
女性	15(32.6)	17(37.0)
年龄(岁, $x ¯$ ±s)	59.6±10.0	58.5±11.3	t=0.762	0.431
体质量 (kg, $x ¯$ ±s)	65.0±12.3	67.0±11.1	t=0.818	0.512
术前血红蛋白(g/L, $x ¯$ ±s)	120.0±23.3	123.0±22.4	t=0.629	0.428
术前红细胞比容(%, $x ¯$ ±s)	37.0±6.4	36.0±7.6	t=0.859	0.526

表1

表2

不同观察项目在两组患者围手术期的情况分析

观察项目	观察组(46例)	对照组(46例)	t值	P值
手术时间(min, $x ¯$ ±s)	149.0±23.8	145.0±26.3	0.765	0.443
术中出血量(ml, $x ¯$ ±s)	344.0±120.0	360.0±134.0	0.603	0.402
术后24h引流量(ml, $x ¯$ ±s)	64.0±23.3	77.0±33.1	2.178	0.042
术后72h引流量(ml, $x ¯$ ±s)	159.0±25.2	174.0±27.2	2.743	0.032
术后3d红细胞比容(%, $x ¯$ ±s)	32.1±8.3	28.2±10.2	2.014	0.048
术后3d血红蛋白下降值(g/L, $x ¯$ ±s)	28.2±8.1	32.5±9.6	2.324	0.037
术后3d凝血酶原时间(s, $x ¯$ ±s)	13.1±3.2	12.6±2.9	0.835	0.517
术后3d活化部分凝血酶原时间(s, $x ¯$ ±s)	36.1±6.1	34.6±5.6	1.229	0.224
术后1周血D-二聚体水平(mg/L, $x ¯$ ±s)	0.9±0.2	0.9±0.3	0.366	0.712

表2

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