Abstract：【Objective】To explore the initial effect of local irrigation of tranexamic acid (TXA) combined with intravenous administration of TXA in posterior lumbar spine surgery. 【Methods】Retrospective analysis was performed on the clinical data of patients undergoing lumbar posterior approach surgery from November 2018 to September 2019. According to the use of TXA,they were divided into the combined use group (local irrigation combined intravenous infusion of TXA), the local use group (local use of TXA alone) and the control group, with 32 cases in each group. Hemoglobin (Hb), plasma D-Dimer (D-D) and Japanese Orthopaedic Association scores (JOA) were compared among the three groups before and after operation. Intraoperative bleeding volume, operation time, operation field quality score and postoperative drainage volume were recorded. Total fluid loss was calculated. Blood loss, intraoperative field, postoperative fibrinolysis and operation effect of TXA were evaluated. Postoperative complications were recorded. 【Results】All patients were followed up for 6 months after surgery. Intraoperative blood loss, postoperative drainage volume, total fluid loss, operation time and Fromme surgical field scores in the combined use group were lower than those in the local use group, while those in the local use group were lower than those in the control group. There was no significant difference in plasma D-D among the three groups before and after operation (P>0.05). The HB value in the combined group was higher than that in the local use group and the control group (P<0.05). The improvement rate of JOA score in the combination group was 72.9%, which was not significantly different from that in the local use group (70.5%) and the control group (69.6%) (P>0.05). The visual field scores of the combined group were significantly lower than those of the local use group and the control group (P<0.05). Two weeks after operation, color Doppler ultrasound examination of both lower limbs was performed in all three groups, and no deep vein thrombosis was found; no pulmonary embolism, cerebrospinal fluid leakage, cerebral infarction, epilepsy and other complications occurred in all three groups. 【Conclusion】Intravenous combined local use TXA can reduce overall blood loss in patients with posterior lumbar surgery, improve intraoperative vision, reduce the operation time, and does not increase the risk of postoperative thrombosis.
罗灿, 刘静男, 卢政好, 吴志良, 欧军. 氨甲环酸局部冲洗联合静脉滴注在腰椎后路手术中的应用价值*[J]. 医学临床研究, 2021, 38(1): 35-38.
LUO Can, LIU Jing-nan, LU Zheng-hao, et al. Application Value of Local Irrigation Combined with Intravenous Infusion of Tranexamic Acid in Posterior Lumbar Spine Surgery. JOURNAL OF CLINICAL RESEARCH, 2021, 38(1): 35-38.
[1] Zhang QH, Teo EC.Finite element application in implant research for treatment of lumbar degenerative disc disease[J].Med Eng Phys,2008,30(10):1246-1256. [2] Engel JM, Hohaus T, Ruwoldt R,et al.Regional hemostatic status and blood requirements after total knee arthroplasty with and without tranexamic acid or aprotinin[J].Anesth Analg,2001,92(3):775-780. [3] 周宗科,黄泽宇,杨惠林,等.中国骨科手术加速康复围术期氨甲环酸与抗凝血药物应用的专家共识[J].中华骨与关节外科杂志,2019,12(2):81-88. [4] Lin S, Chen C, Yao CF,et al. Comparison of different hypotensive anaesthesia techniques in orthognathic surgery with regard to intraoperative blood loss, quality of the surgical field, and postoperative nausea and vomiting[J].Int J Oral Maxillofac Surg,2016,45(12):1526-1530. [5] Gross JB.Estimating allowable blood loss:corrected for dilution[J].Anesthesiology,1983,58(3):277-280. [6] Jing Tao-Zhang,Fan Tao-Meng,Shuai Wang,et al. Predictors of surgical outcome in cervical spondylotic myelopathy: focusing on the quantitative signal intensity[J].Eur Spine J,2015,24(12):2941-2945. [7] Roy SP, Tanki UF, Dutta A,et al. Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty[J].Knee Surg Sports Traumatol Arthrosc,2012,20(12):2494-2501. [8] Kalavrouziotis D, Voisine P, Mohammadi S, et al.High-dose tranexamic acid is an independent predictor of early seizure after cardiopulmonary bypass[J].Ann Thorac Surg,2012,93(1):148-154.
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