Department of Orthopedic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province.
Department of Cardiology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, Shandong Province, People's Republic of China.
Clin Spine Surg. 2020 Dec;33(10):E593-E597. doi: 10.1097/BSD.0000000000000999.
Tranexamic acid (TXA) has been widely used in hip and knee arthroplasty to reduce perioperative blood loss and blood transfusion, but the dosage and efficacy of TXA in posterior lumbar spinal surgery are not fully clear. The aim of this study was to investigate the efficacy and safety of TXA and to determine whether 2 doses of TXA could reduce the blood loss in primary single-segment or double-segment posterior lumbar fusion surgery.
A total of 150 patients with lumbar degenerative disease undergoing posterior lumbar interbody fusion surgery between October 2017 and February 2019 were randomized to 3 groups. Group A was treated with 0.9% normal saline solution without TXA, group B was treated with a 15 mg/kg loading dose intravenous infusion 30 minutes before surgery, and group C was treated with a 15 mg/kg loading dose intravenous infusion 30 minutes before surgery; then, the same dose was administered again 3 hours later. The assessed outcomes were the operation time, the total blood loss, the hidden blood loss, postoperative drainage, blood transfusions, incidence of venous thromboembolism, and incision infection.
The total blood loss, the hidden blood loss, and postoperative drainage were the lowest in group C. The amount of intraoperative blood loss was similar among the 3 groups. The hemoglobin and hematocrit values of the third postoperative day were the highest in group C. No significant differences in the incidence of complications and adverse events from TXA use were observed among the 3 groups. The use of TXA, the operation time, and the number of fusion segments were identified as risk factors related to total blood loss.
Two doses of TXA significantly reduced the total blood loss, the hidden blood loss and postoperative drainage, and decreased hemoglobin and hematocrit drop in patients undergoing posterior lumbar fusion without increasing the risk of complications.
氨甲环酸（TXA）已广泛应用于髋关节和膝关节置换术，以减少围手术期失血和输血，但 TXA 在腰椎后路手术中的剂量和疗效尚不完全清楚。本研究旨在探讨 TXA 的疗效和安全性，以及两种剂量的 TXA 是否可以减少原发性单节段或双节段后路腰椎融合手术的失血量。
2017 年 10 月至 2019 年 2 月，150 例腰椎退行性疾病患者接受后路腰椎椎间融合术，随机分为 3 组。A 组给予 0.9%生理盐水溶液，不给予 TXA；B 组于术前 30 分钟给予 15mg/kg 负荷剂量静脉输注；C 组于术前 30 分钟给予 15mg/kg 负荷剂量静脉输注，然后 3 小时后再次给予相同剂量。评估的结果包括手术时间、总失血量、隐匿性失血量、术后引流、输血、静脉血栓栓塞和切口感染的发生率。
C 组的总失血量、隐匿性失血量和术后引流量最低。三组术中出血量相似。C 组术后第 3 天血红蛋白和红细胞压积值最高。三组患者使用 TXA 的并发症和不良事件发生率无显著差异。TXA 的使用、手术时间和融合节段数被确定为与总失血量相关的危险因素。
两剂 TXA 可显著减少后路腰椎融合患者的总失血量、隐匿性失血量和术后引流量，并降低血红蛋白和红细胞压积下降，而不增加并发症的风险。
