氨甲环酸在腰椎退变性侧凸患者截骨矫形长节段固定术中的应用

The application of tranexamic acid in degenerative lumbar scoliosis patients undergoing posterior osteotomy and multi-level posterior spinal segmental instrumented fusion

中文关键词:  氨甲环酸  退变性腰椎侧凸  长节段固定融合  输血

英文关键词:Tranexamic acid  Degenerative lumbar scoliosis  Multi-level spinal instrumented fusion  Transfusion

中文摘要:

  【摘要】 目的：探讨氨甲环酸在腰椎退变性侧凸（DLS）患者截骨矫形长节段固定融合手术中的有效性及安全性。方法：本研究回顾性纳入101例行长节段（≥4节段）固定融合截骨矫形的DLS患者，术中使用氨甲环酸（TXA）的患者纳入氨甲环酸组（TXA组），术中未使用TXA的患者输入等量生理盐水并纳入对照组（Placebo组）。比较两组患者术前和术后6周内的相关资料，包括患者的基本信息、并发症、手术相关资料、术中出血量（IBL）、术后引流量、总出血量（TBL）、围术期输血量和输血率、输血费用以及围手术期并发症。采用多元回归分析的方法，探讨围术期总出血量、异体输血量和输血成本的独立危险因素。结果：41例患者纳入氨甲环酸组，对照组60例患者，两组之间的基线数据、影像学参数、术前凝血指标和肝肾功能无统计学差异。TXA组患者术中出血量（TXA组1245.22±770.61ml vs 对照组1633.65±962.49ml， P=0.021）、术后引流量（TXA组1205.68±367.76 ml vs 对照组1412.83±538.45ml，P=0.035）及总出血量（TXA组2450.90±1022.69ml vs 对照组3046.48±1274.02ml，P=0.011）均显著小于对照组患者。TXA组术中自体血回输量为400.44±267.80ml，对照组为526.22±339.96ml，二者之间具有统计学显著性（P=0.031），TXA组患者术中异体输血量及输血率也均显著小于对照组（TXA组468.29±391.43ml vs 723.33±462.99ml，P=0.009；TXA组68.29% vs 对照组86.67%，P=0.025）。TXA组围术期总输血量为746.34±460.49ml，显著小于对照组（1143.33±669.02ml）。TXA组患者围术期输血费为969.76±840.24元，而对照组输血费为1460.67±1029.51元，使用TXA可明显减少围术期输血费（P=0.005）。多因素回归分析结果提示，在其他因素不变的情况下，术中使用1g TXA可减少围术期出血689.89ml，减少异体输血390.26ml，减少输血费用549.11元。使用TXA没有发现明显并发症或副作用。结论：在腰椎退变性侧凸患者行截骨矫形长节段固定融合手术中使用TXA是有效、安全，并可以显著降低医疗费用成本。

英文摘要:

  【Abstract】 Objectives: To evaluate the efficacy and safety of tranexamic acid in degenerative lumbar scoliosis(DLS) patients undergoing posterior osteotomy and multi-level spinal segmental instrumented fusion surgery. Methods: A total of 101 consecutive patients undergoing posterior osteotomy and multi-level spinal segmental instrumented fusion(≥4 levels) was analyzed retrospectively. Patients receiving intraoperative tranexamic acid(TXA) were included in the tranexamic acid group(TXA group), while patients not receiving intraoperative TXA were given the same amount of saline and included in the control group(Placebo group). Preoperative and postoperative data within 6 weeks were compared between the two groups, including patient basic information, complications, surgical data, postoperative complications and medical costs. Outcome parameters included intra-operative blood loss(IBL), postoperative drainage, total blood loss(TBL), perioperative transfusion amount, rate of transfusion, transfusion cost and perioperative complications. Enter multiple regression analysis was performed to investigate the independent risk factors of TBL, transfusion value and the cost of transfusion. Results: 41 patients were enrolled in the TXA group, and 60 patients were in the Placebo group. There was no statistical difference in the baseline data, preoperative radiographic parameters and laboratory parameters between the groups. There was a significant decrease in the IBL(TXA group 1245.22±770.61ml vs Placebo group 1633.65±962.49ml, P=0.021), postoperative drainage(TXA group 1205.68±367.76ml vs Placebo group 1412.83±538.45ml, P=0.035) and TBL(TXA group 2450.90±1022.69ml vs Placebo group 3046.48±1274.02ml, P=0.011). In the TXA group, intraoperative autologous blood transfusion volume was 400.44±267.80ml, while in the control group it was 526.22±339.96ml, showing statistical significance(P=0.031). The intraoperative allogeneic blood transfusion volume and transfusion rate of patients in the TXA group were also significantly lower than those in the control group(TXA group 468.29±391.43ml vs Placebo group 723.33±462.99ml, P=0.009; TXA group 68.29% vs Placebo group 86.67%, P=0.025). The total perioperative blood transfusion volume of the TXA group was 746.34±460.49ml, significantly lower than that of the control group (1143.33±669.02ml). The perioperative blood transfusion cost of the TXA group was 969.76±840.24 yuan, while that of the control group was 1460.67±1029.51 yuan, TXA could significantly reduce perioperative blood transfusion cost(P=0.005). Based on multiple regression analysis, intra-operative use of 1g TXA could reduce the amount of TBL, total allogenic transfusion, transfusion cost by 689.89ml, 390.26ml and 549.11 respectively. No complication or side effect from the use of TXA was noted. Conclusions: The use of TXA in DLS patients undergoing posterior osteotomy and multi-level spinal segmental instrumented fusion surgery seems to be valid, safe and cost-effective.