Bullmann V, Granitzka M
Klinik für Wirbelsäulenchirurgie/Orthopädie II, St. Franziskus-Hospital Köln, Schönsteinstraße 63, 50825, Köln, Deutschland.
Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, St. Franziskus-Hospital Köln, Köln, Deutschland.
Orthopade. 2018 Apr;47(4):296-300. doi: 10.1007/s00132-018-3535-6.
Blood management in reconstructive spine surgery is a challenge and must be managed interdisciplinarily. An experienced team of anesthesiologists and spine surgeons needs to work closely together.
After optimal preoperative preparation, the patient is given an initial dose of 1000 mg tranexamic acid. The most adequate medium blood pressure is about 80 mm Hg during surgery. The surgeon must watch for subperiosteal preparation and subtle stypsis. A cell saver is used. If the expected blood loss exceeds 1000 ml, additional tranexamic acid of 1000 mg/6 h will be infused. Epidural bleeding as well as bony hemorrhage are challenges for the spine surgeon. Epidural veins should be coagulated under the microscope before they bleed. Bone wax should be used in bony bleeding. If bleeding is uncontrollable, industrially produced hemostyptics can be used.
POST-TREATMENT: Postoperatively the risk of bleeding should be minimized under critical observation of coagulation and blood pressure. Also, a critical assessment of the anticoagulation is to be made. The drainage rate should be well documented. The surgeon must decide whether the drain is to be put on suction or on overflow. He must also decide when to remove the drainage.
脊柱重建手术中的血液管理是一项挑战，必须进行多学科管理。经验丰富的麻醉医生和脊柱外科医生团队需要密切合作。
在进行最佳的术前准备后，给患者静脉注射1000毫克氨甲环酸初始剂量。手术期间最适宜的平均血压约为80毫米汞柱。外科医生必须注意骨膜下操作和细微的止血情况。使用血液回收机。如果预计失血量超过1000毫升，将以1000毫克/6小时的剂量额外输注氨甲环酸。硬膜外出血和骨质出血对脊柱外科医生来说是挑战。硬膜外静脉在出血前应在显微镜下进行凝固。骨质出血时应使用骨蜡。如果出血无法控制，可以使用工业生产的止血剂。
术后，在密切观察凝血功能和血压的情况下，应将出血风险降至最低。此外，还应对抗凝情况进行严格评估。引流速度应详细记录。外科医生必须决定引流管是采用负压吸引还是自然引流。他还必须决定何时拔除引流管。
