CAJ | 학술논문

目的：观察静脉联合局部应用氨甲环酸（ tranexamic acid，TXA）减少腰椎后路减压内固定融合术围术期失血的有效性及安全性。方法选取腰椎后路减压内固定融合术患者共128例，其中治疗组64例：于术切皮前静脉输注500 mg TXA，术中使用TXA浸湿的方纱局部浸润压迫止血；对照组64例：TXA换成生理盐水，操作同治疗组。观察并比较2组患者一般资料及相关指标变化。结果2组患者一般资料比较差异均无统计学意义。与对照组相比，治疗组术中出血量、输血量、术后24h引流量、术后6h自体血回输量均显著减少（ P＜0．01）。治疗组患者术后次日晨血红蛋白浓度及术后3日晨血红蛋白浓度、红细胞压积指标明显高于对照组患者（P＜0．05）。2组患者凝血酶原时间、纤维蛋白原含量比较差异均无统计学意义。治疗组患者术后住院时间短于对照组（P＜0．01）。2组患者术后均无深静脉血栓等并发症发生。结论采用静脉联合局部运用氨甲环酸可明显减少腰椎后路减压内固定融合术术中及术后出血量，缩短患者住院时间，且未增加血栓性疾病的风险。
목적：관찰정맥연합국부응용안갑배산（ tranexamic acid，TXA）감소요추후로감압내고정융합술위술기실혈적유효성급안전성。방법선취요추후로감압내고정융합술환자공128례，기중치료조64례：우술절피전정맥수주500 mg TXA，술중사용TXA침습적방사국부침윤압박지혈；대조조64례：TXA환성생리염수，조작동치료조。관찰병비교2조환자일반자료급상관지표변화。결과2조환자일반자료비교차이균무통계학의의。여대조조상비，치료조술중출혈량、수혈량、술후24h인류량、술후6h자체혈회수량균현저감소（ P＜0．01）。치료조환자술후차일신혈홍단백농도급술후3일신혈홍단백농도、홍세포압적지표명현고우대조조환자（P＜0．05）。2조환자응혈매원시간、섬유단백원함량비교차이균무통계학의의。치료조환자술후주원시간단우대조조（P＜0．01）。2조환자술후균무심정맥혈전등병발증발생。결론채용정맥연합국부운용안갑배산가명현감소요추후로감압내고정융합술술중급술후출혈량，축단환자주원시간，차미증가혈전성질병적풍험。
Objective To explore the efficacy and safety of intravenous injection combined with topical application of TXA in reducing perioperative blood loss in patients with posterior lumbar internal fixation fusion operation.Methods A total of 128 patients undergoing posterior lumbar internal fixation fusion operation were divided into two groups.Treatment group (64 cases):500 mg TXA was intravenously given before operation, and using TXA-soaked gauze to stop bleeding; control group (64 cases): TXA was replaced with physiological saline and the patients were given the same process.General information and related indexes were observed and compared between two groups.ResuIts There were no statistical differences of general information between the two groups.The intraoperative bleeding and transfusion, volume of drainage after 12 h surgery, volume of autologous blood transfusion after 6h surgery in treatment group were lower than those in control group (P<0.01).The hemoglobin and D-dimer concentrations on the next day morning after surgery, hemoglobin concentration and hematokrit on the third day after surgery in treatment group were higher than those in control group(P<0.05).There were no significant differences of prothrombin time and fibrinogen content between two groups.The postoperative length of stay of treatment group was shorter than that of control group (P<0.01).There were no complications like deep vein thrombosis occurred in two group. ConcIusion Intravenous injection combined with topical application of tranexamic acid in patients with lumbar surgery could significantly reduce tra-and post-operative bleeding and shortern hospital stay without increasing risk of thrombosis.