大剂量氨甲环酸用于脊柱矫形手术的安全性和有效性

Efficacy and safety of high-dosage of tranexamic acid during spine correction surgery

中文关键词:  脊柱畸形  脊柱矫形手术  经后路全椎体切除术  氨甲环酸  失血  输血

英文关键词:Spine deformities  Spine correction surgery  Posterior vertebral column resection  Tranexamic acid  Blood loss  Blood transfusion

中文摘要:

  【摘要】 目的：评价大剂量氨甲环酸（TXA）应用于脊柱矫形手术尤其是经后路全脊椎切除术（PVCR）的安全性及有效性。方法：2009年2月~2010年10月收治脊柱畸形患者共66例，术前凝血功能检查异常及长期服用影响凝血功能药物的患者共7例被排除，最终59例患者纳入本研究。其中严重僵硬性脊柱畸形患者均接受一期PVCR，其余患者均接受一期单纯后路矫形融合术，所有手术均由同一位医师主刀完成。患者被分为TXA组和对照组。TXA组中8例接受PVCR，18例接受非PVCR矫形手术；对照组中9例接受PVCR，24例接受非PVCR矫形手术。TXA组患者在切皮前20min静脉输入100mg/kg剂量的TXA，随后给予维持量10mg·kg-1·h-1的TXA直到切口关闭；对照组给予等量的生理盐水替代。统计患者的术中失血量、真实失血量、输血量等数据，并监测患者围手术期的凝血功能、血红蛋白、红细胞比容等，同时监测药物相关并发症，包括潜在的肝、肾功能损伤，上/下肢静脉血栓，肺栓塞，心肌梗死及癫痫等。结果：TXA组中接受PVCR的患者术中失血量（4219±1386ml）、真实失血量[（134.2±36.4）%]及输血量（2986±1458ml）均少于对照组接受PVCR手术的患者[分别为9906±5251ml，（332.9±191.8）%，6255±3401ml，均P<0.05]。TXA组中接受非PVCR矫形手术患者的术中失血量、真实失血量及输血量也均小于对照组非PVCR矫形手术患者（P<0.05）。TXA组中PVCR术中失血量较对照组PVCR减少57.4%，而非PVCR手术术中失血量减少39.8%，大剂量TXA减少术中失血的作用在PVCR术中更为明显。TXA组及对照组围手术期肝、肾功能指标无明显差异（P＞0.05）。TXA组中未出现上/下肢静脉血栓、肺栓塞、心肌梗死、癫痫及急性肾功能衰竭。结论：大剂量TXA可有效减少脊柱矫形手术的术中失血与输血，尤其在PVCR手术中大剂量TXA的效果更为突出；大剂量TXA在脊柱矫形手术中的使用是安全的。

英文摘要:

  【Abstract】 Objectives: To assess the efficacy and safety of high dosage of tranexamic acid(TXA) during spine correction surgery, especially in posterior vertebral column resection(PVCR) procedures. Methods: Sixty-six patients undergoing posterior spine correction surgery from February 2009 to October 2010 were selected in this study. Seven patients with bleeding disorder or taking medicine which possibly affected coagulation were excluded in the current study. Finally, fifty nine(59) patients were enrolled in the current study. The patients with severe rigid spine deformity underwent PVCR and the others underwent simple posterior spine correction surgery, all procedures were performed by the same surgeon. Patients were divided into two groups: TXA group and control group. 8 patients treated with PVCR and 18 patients treated with non-PVCR were in TXA group; 9 patients treated with PVCR and 24 patients treated with non-PVCR were in control group. In the TXA group, an intravenous loading dose of TXA at 100mg/kg was given over a 20 minute period before skin incision followed by a continuous infusion of 10mg·kg-1·h-1 until the skin closure. The equal amount of normal saline(NS) was given to the patients in control group. The role of TXA on the blood loss(BL), real blood loss(RBL)[RBL=BL/BV(blood volume)] was studied, as well as the amount of acquired blood transfusion, coagulation indexes, hemoglobin，hematocrit and the drug adverse reaction, such as potential liver damage, renal toxicity, deep vein thrombosis(DVT) at upper/lower extremities, pulmonary embolism(PE), myocardial infarction(MI) and seizure. Results: There were significantly less BL(4219±1386ml), RBL[(134.2±36.4)%] and blood transfusion(2986±1458ml) in patients treated with PVCR in TXA group compared with those[9906±5251ml, P<0.05; (332.9±191.8)%, P<0.05 and 6255±3401ml, P<0.05] in control group. The BL, RBL and blood transfusion were also less in patients treated with non-PVCR procedure(P<0.05). High dose of TXA decreased by 57.4% of BL in the patients receiving PVCR and decreased by 39.8% of BL in the patients receiving non-PVCR. The greater benefit of TXA was observed in these patients who had PVCR procedure. There were no differences in liver and renal function between the two groups. And no thrombus at upper/low extremities, PE, MI, seizures and acute renal failure detected in TXA group. Conclusions: High dose of TXA can effectively decrease BL and the amount of blood transfusions in spinal correction surgery, especially in PVCR procedure. Meanwhile, high dose of TXA is safe in spinal correction surgery.