青少年特发性脊柱侧凸矫形术中应用氨甲环酸的有效性和安全性

Use of tranexamic acid in corrective surgery for adolescent idiopathic scoliosis: effectiveness and safety

中文关键词:  青少年特发性脊柱侧凸  出血量  氨甲环酸  围手术期

英文关键词:Adolescent idiopathic scoliosis  Blood loss  Tranexamic acid  Perioperative period

中文摘要:

  【摘要】 目的：评估在青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）矫形手术中静脉应用氨甲环酸（tranexamic acid，TXA）以减少出血的有效性及安全性。方法：回顾性分析2016年11月~2022年5月在南京鼓楼医院脊柱外科行后路矫形内固定融合术治疗的759例AIS患者的临床资料，女544例， 男215例； 年龄14.7±2.1岁。其中369例术中静脉应用TXA的患者纳入TXA组，390例术中未使用 TXA但输入等量生理盐水的患者纳入对照组。比较两组患者基本信息（年龄、性别比、侧凸Cobb角和侧凸类型）、术前和术后3天的血液实验室指标[血红蛋白（hemoglobin，Hb）、红细胞压积（hematocrit，Hct）、血小板计数（platelet，PLT）、凝血酶原时间（prothrombin time，PT）、D-二聚体、部分凝血活酶时间（activated partial thromboplastin time，APTT）及纤维蛋白原（fibrinogen，FIB）]、血液管理资料（术中出血量、术中输血量、术后引流量和拔管时间）及矫正手术相关指标（术前术后侧凸度数、矫正率）和术后并发症。结果：两组患者的基本信息、术前血液实验室指标均无统计学差异（P＞0.05）。TXA组患者术中出血量（551.7±130.3mL）、总输血量（551.3±96.3mL）、术后引流量（468.3±162.5mL）、术后引流天数（2.8±0.4d）均显著性低于对照组（666.7±166.8mL、650.0±138.3mL、550.0±135.1mL、3.1±0.8d，P<0.05），术后D二聚体和PLT显著性低于对照组（P<0.05），其余血液实验室指标两组间无显著性差异（P>0.05）。两组侧凸矫正率、术后并发症谱及发生率无统计学差异（P>0.05）。结论：术中应用TXA可以减少AIS患者围手术期的出血量、输血量，改善凝血指标，且不会增加相关并发症发生率。

英文摘要:

  【Abstract】 Objectives： To assess the efficacy and safety of intravenous use of tranexamic acid(TXA) in reducing blood loss during correction surgery for patients with adolescent idiopathic scoliosis(AIS). Methods： The clinical data of 759 AIS patients who underwent posterior corrective fusion surgery at Nanjing Drum Tower Hospital between November 2016 and May 2022 were reviewed retrospectively. There were 544 females and 215 males, with an average age of 14.7±2.1 years. Among the patients, 369 patients receiving intravenous use of TXA during surgery were included in the TXA group, while the other 390 patients receiving the same volume of saline but not TXA were included in the control group. The baseline data(age, gender ratio, Cobb angle, and scoliosis type), pre- and postoperative blood laboratory parameters[hemoglobin(Hb), hematocrit(Hct), platelet count(PLT), prothrombin time(PT), D-dimer, activated partial thromboplastin time(APTT), and fibrinogen(FIB)], blood management indicators(intraoperative blood loss, intraoperative blood transfusion, postoperative drainage volume and removal time of drainage tube), and correction-related indicators(pre- and postoperative scoliosis degree, correction rate) and postoperative complications were compared between the two groups． Results: There were no significant differences in baseline data and preoperative blood laboratory parameters between the groups(P>0.05). In TXA group, the intraoperative blood loss(551.7±130.3mL), intraoperative blood transfusion volume(551.3±96.3mL), postoperative drainage volume(468.3±162.5mL), and postoperative drainage time(2.8±0.4d) were all significantly lower than those in the control group(666.7±166.8mL, 650.0±138.3mL, 550.0±135.1mL, 3.1±0.8d, P<0.05). Postoperative D-dimer and PLT in the TXA group were significantly lower than those in the control group(P<0.05), while other blood laboratory parameters showed no significant differences between the two groups(P>0.05). There were no statistically significant differences in scoliosis correction rates, postoperative complication rates between the two groups(P>0.05). Conclusions: The use of TXA in surgery can reduce the perioperative blood loss and transfusion, and improve coagulation status in AIS patients, without increasing the incidence rates of complications.