氨甲环酸在肺癌脊柱转移瘤后路减压固定手术中应用的安全性和有效性

Safety and efficacy of administration of tranexamic acid in posterior decompression fixation surgery of lung cancer spinal metastases

中文关键词:  脊柱转移瘤  肺癌  氨甲环酸  失血  输血

英文关键词:Spinal metastases  Lung cancer  Tranexamic acid  Blood loss  Blood transfusion

中文摘要:

  【摘要】 目的：评估静脉注射氨甲环酸（tranexamic acid，TXA）在减少肺癌脊柱转移瘤患者后路减压手术的围手术期失血量的安全性和有效性。方法：回顾性分析2011年5月~2022 年8月期间收治的接受减压手术的肺癌脊柱转移患者68 例，年龄63.1±1.3 岁，其中男性42 例，女性26例。根据患者从开始麻醉到手术30min内是否接受TXA（1g，静脉注射）分为观察组（26例）和对照组（46例）。收集患者资料：一般资料[包括年龄、性别、（American society of Aneshesiologists physical status classification system，ASA）分级、口服抗凝或抗血小板药物的应用情况]、肿瘤相关资料（包括病理类型和系统治疗）、实验室相关资料（包括术前HGB、Hct、PLT、PT、APTT和术后1d Hct）、手术相关资料（包括减压部位、显露节段、手术类型、手术时间、手术当天的输血量、术后引流量和引流管留置时间以及术后住院情况）和术后住院期间下肢静脉血栓相关资料。采用Gross公式计算总失血量。采用t检验、曼-惠特尼U检验和卡方检验比较两组间的差异。结果：两组患者年龄、性别、ASA分级、病理类型、抗凝或抗血小板药物等一般资料和肿瘤相关资料无统计学差异（P>0.05）。观察组患者术前HGB显著性低于对照组（P=0.035），术前Hct、PLT、PT、APTT以及术后1d Hct等资料无统计学差异（P>0.05）。两组患者在手术减压部位、手术方式、手术显露节段和手术时间上无统计学差异（P>0.05）。观察组失血量明显低于对照组[961.3.4（741.5，1810.4）mL vs 1593.5（1170.2，1936.1）mL，P=0.013]，输血量明显少于对照组[400（0，800）mL vs 800（400，800）mL，P=0.024]。两组在引流量、引流时间、术后住院时间和术后新发下肢静脉血栓方面无统计学差异（P>0.05）。结论：开始麻醉到手术30min内静脉注射1g TXA能够减少肺癌脊柱转移患者后路减压手术的失血量和输血量。

英文摘要:

  【Abstract】 Objectives: To evaluate the safety and efficacy of intravenous injection of tranexamic acid(TXA) in reducing the perioperative blood loss in patients with lung cancer spinal metastases undergoing posterior decompression surgery. Methods: A retrospective analysis was conducted on 68 patients with lung cancer spinal metastases who underwent decompression surgery between May 2011 and August 2022, with an average age of 63.1±1.3 years. Among them, there were 42 males and 26 females. According to whether received intravenous injection of 1g TXA after the start of anesthesia to operation within 30mins, the patients were divided into observation group(26 cases) and control group(46 cases). The following data were collected including general information[age, gender, American Society of Aneshesiologists physical status classification system(ASA) grade, and the use of oral anticoagulant or antiplatelet drugs], tumor related information(pathological types and systemic treatments), laboratory related information(preoperative HGB, Hct, PLT, PT, APTT, and postoperative 1d Hct), and surgical related information(decompression site, exposed segment, surgical type, surgical time, blood transfusion volume on the day of surgery, postoperative drainage volume and drainage tube retention time, and postoperative hospitalization status), as well as the data related to lower limb venous thrombosis during postoperative hospitalization. The total blood loss was calculated using Gross′s formula. t-test, Mann Whitney U test, and chi square test were used to evaluate the differences between the two groups. Results: There were no statistically significant differences between the two groups of patients in general information and tumor-related information such as age, gender, ASA grading, pathological type, and the use of oral anticoagulant or antiplatelet drugs(P>0.05). The preoperative HGB levels in the observation group were significantly lower than those in the control group(P=0.035), while there were no statistically significant differences in other preoperative laboratory data such as Hct, PLT, PT, and APTT(P>0.05). There were no statistically significant differences between the two groups of patients in terms of surgical decompression site, surgical type, exposed segment, and surgical time(P>0.05). The blood loss in the observation group was significantly lower than that in the control group[961.3.4(741.5, 1810.4)mL vs 1593.5(1170.2, 1936.1)mL, P=0.013]. The blood transfusion volume of the observation group was significantly lower than that of the control group[400(0, 800)mL vs 800(400, 800)mL, P=0.024]. There were no significant differences between the two groups in terms of drainage volume, drainage tube retention time, postoperative hospitalization time, and newly developed lower limb venous thrombosis after surgery(P>0.05). Conclusions: Intravenous injection of 1g TXA after the start of anesthesia to operation within 30mins can reduce the blood loss and transfusion volume in patients with lung cancer spinal metastases undergoing posterior decompression surgery.