中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2011年
29期
17-20
,共4页
椎管狭窄%脊柱融合术%氨甲环酸%失血,手术
椎管狹窄%脊柱融閤術%氨甲環痠%失血,手術
추관협착%척주융합술%안갑배산%실혈,수술
Spinal stenosis%Spine fusion%Tranexamic acid%Blood loss,surgical
目的 探讨氨甲环酸对高龄伴多节段腰椎管狭窄患者围手术期失血量的影响及安全性.方法 2009年1月至2010年9月,对连续就诊的68例行多节段腰椎管减压的高龄腰椎管狭窄患者(年龄≥65岁)进行前瞻性随机对照研究.采用机械抽样法随机分为两组,每组34例,对照组采用常规治疗,试验组在常规治疗的基础上加用氨甲环酸.对两组术中失血量、术后引流量、输浓缩红细胞、输血例数、血红蛋白、凝血酶原时间等指标进行比较.观察患者术后是否出现下肢深静脉栓塞的临床症状.结果 试验组患者术中失血量、术后引流量、输浓缩红细胞和输血例数较对照组患者显著下降[分别为(641.1±128.4) ml比(780.1±107.3) ml,(228.80±52.07) ml比(345.50±42.16)ml,(1.02±1.56)U比(2.89±1.76)U,16例比28例](p＜0.05),术后血红蛋白[(104.00±4.87) g/L]明显高于对照组[ (92.20±5.47) g/L](P＜ 0.05).两组患者术前及术后凝血酶原时间和活化部分凝血活酶时间比较差异无统计学意义(P＞0.05).所有患者的手术切口均为Ⅰ期愈合,无明显深静脉栓塞的临床症状,术后7d彩色多普勒超声检查未见下肢深静脉血栓形成.结论 对高龄伴多节段腰椎管狭窄患者进行后路手术时,于术中及术后短期使用氨甲环酸能明显降低患者术中失血量及输血量,并且不增加静脉血栓形成的风险.
目的 探討氨甲環痠對高齡伴多節段腰椎管狹窄患者圍手術期失血量的影響及安全性.方法 2009年1月至2010年9月,對連續就診的68例行多節段腰椎管減壓的高齡腰椎管狹窄患者(年齡≥65歲)進行前瞻性隨機對照研究.採用機械抽樣法隨機分為兩組,每組34例,對照組採用常規治療,試驗組在常規治療的基礎上加用氨甲環痠.對兩組術中失血量、術後引流量、輸濃縮紅細胞、輸血例數、血紅蛋白、凝血酶原時間等指標進行比較.觀察患者術後是否齣現下肢深靜脈栓塞的臨床癥狀.結果 試驗組患者術中失血量、術後引流量、輸濃縮紅細胞和輸血例數較對照組患者顯著下降[分彆為(641.1±128.4) ml比(780.1±107.3) ml,(228.80±52.07) ml比(345.50±42.16)ml,(1.02±1.56)U比(2.89±1.76)U,16例比28例](p＜0.05),術後血紅蛋白[(104.00±4.87) g/L]明顯高于對照組[ (92.20±5.47) g/L](P＜ 0.05).兩組患者術前及術後凝血酶原時間和活化部分凝血活酶時間比較差異無統計學意義(P＞0.05).所有患者的手術切口均為Ⅰ期愈閤,無明顯深靜脈栓塞的臨床癥狀,術後7d綵色多普勒超聲檢查未見下肢深靜脈血栓形成.結論 對高齡伴多節段腰椎管狹窄患者進行後路手術時,于術中及術後短期使用氨甲環痠能明顯降低患者術中失血量及輸血量,併且不增加靜脈血栓形成的風險.
목적 탐토안갑배산대고령반다절단요추관협착환자위수술기실혈량적영향급안전성.방법 2009년1월지2010년9월,대련속취진적68례행다절단요추관감압적고령요추관협착환자(년령≥65세)진행전첨성수궤대조연구.채용궤계추양법수궤분위량조,매조34례,대조조채용상규치료,시험조재상규치료적기출상가용안갑배산.대량조술중실혈량、술후인류량、수농축홍세포、수혈례수、혈홍단백、응혈매원시간등지표진행비교.관찰환자술후시부출현하지심정맥전새적림상증상.결과 시험조환자술중실혈량、술후인류량、수농축홍세포화수혈례수교대조조환자현저하강[분별위(641.1±128.4) ml비(780.1±107.3) ml,(228.80±52.07) ml비(345.50±42.16)ml,(1.02±1.56)U비(2.89±1.76)U,16례비28례](p＜0.05),술후혈홍단백[(104.00±4.87) g/L]명현고우대조조[ (92.20±5.47) g/L](P＜ 0.05).량조환자술전급술후응혈매원시간화활화부분응혈활매시간비교차이무통계학의의(P＞0.05).소유환자적수술절구균위Ⅰ기유합,무명현심정맥전새적림상증상,술후7d채색다보륵초성검사미견하지심정맥혈전형성.결론 대고령반다절단요추관협착환자진행후로수술시,우술중급술후단기사용안갑배산능명현강저환자술중실혈량급수혈량,병차불증가정맥혈전형성적풍험.
Objective To investigate the efficacy and safety of tranexamic acid in perioperative blood loss in old patients with multi-level lumbar spinal stenosis.Methods From January 2009 to September 2010,a total of 68 consecutive patients with multi-level lumbar spinal stenosis ( ≥65 years old) underwent posterior decompression,internal fixation and bone graft fusion who were randomly divided into group A and group B with 34 patients in each.The patients in group A received tranexamic acid and the patients in group B received an equal volume of normal saline.The amounts of intraoperative blood loss,postoperative wound drainage,blood transfusion,the number of the patients needing blood transfusion and hemoglobin,fibrinogen,prothrombin time and so on were examined preoperatively and 24 hours postoperatively.All the patients were observed for the clinical symptoms of deep vein thrombosis.Results The amounts of intraoperative blood loss,postoperative wound drainage,blood transfusion and the number of the patients needing blood transfusion in group A were significantly decreased than those in group B[ (641.1 ± 128.4) ml vs.(780.1 ± 107.3) ml,(228.80 ± 52.07) ml vs.(345.50 ±42.16) ml,(1.02 + 1.56) U vs.(2.89 ± 1.76) U,16 cases vs.28 cases ],there were significant differences between two groups (P ＜ 0.05 ).As for the value of postoperative hemoglobin concentration in group A [ ( 104.00 ± 4.87) g/L ] was significantly higher than that in group B [ (92.20 + 5.47 ) g/L ] (P ＜ 0.05 ).There were no significant differences in the levels of fibrinogen,prothrombin time,and activated partial thromboplastin time between two groups (P ＞ 0.05).No deep vein thrombosis was found 7 days postoperatively.Conclusion Tranexamic acid can be effectively used in spine surgery in old patients with multi-level lumbar spinal stenosis without increasing the risk of venous thrombosis.
