Qi Mei-Tao, Wang Shu-Ying, Wang Ling-Ting, Chen Xue-Wu, Zhan Wen-Hao, Zhu Xiao-Feng, Wang Hong
Department of Spine Orthopaedics, Yijishan Hospital, Wannan Medical College, Wuhu 241000, Anhui, China.
Zhongguo Gu Shang. 2022 Aug 25;35(8):736-9. doi: 10.12200/j.issn.1003-0034.2022.08.007.
To explore the effects of different administration methods of tranexamic acid(TXA) on the perioperative blood loss, hidden blood loss, transfusion rate and adverse reactions in lumbar spinal decompression and fusion.
Sixty patients who received lumbar spinal canal decompression and fusion from July 2019 to July 2020 were enrolled and divided into observation group and control group, with 30 cases in each group. The observation group was given 2 g TXA orally at 2 hours before operation, control group was given 1 g TXA for 5-10 min before skin incision and 6 hours after operation intravenously. The intraoperative blood loss, postoperative drainage, total blood loss, hidden blood loss, drainage tube removal time, blood transfusion rate, venous thrombosis rate, adverse event rate were recorded respectively. The changes of hemoglobin(Hb) and hematocrit (HCT) were observed before operation and 1, 3 days after operation.
Hb and HCT at 1 and 3 days after operation were significantly improved compared with those before operation(<0.01). However, there was no significant difference between the groups(>0.05). There were no significant difference in amount of blood loss, postoperative drainage, total blood loss, intraoperative blood loss, hidden blood loss, postoperative drainage time, and blood transfusion rate between two groups (>0.05). There were no venous thrombosis and adverse events occurred in both groups.
During the perioperative period of lumbar spinal decompression and fusion, oral TXA and intravenous TXA have the same effect in reducing perioperative blood loss and are safe and reliable. It is recommended that oral TXA be used to save medical costs and convenience.
探讨氨甲环酸（TXA）不同给药方式对腰椎减压融合术围手术期失血量、隐性失血量、输血率及不良反应的影响。
选取2019年7月至2020年7月行腰椎管减压融合术的60例患者，分为观察组和对照组，每组30例。观察组于术前2小时口服2g TXA，对照组于皮肤切开前5 - 10分钟静脉注射1g TXA，并于术后6小时静脉注射。分别记录术中失血量、术后引流量、总失血量、隐性失血量、引流管拔除时间、输血率、静脉血栓形成率、不良事件发生率。观察术前及术后1、3天血红蛋白（Hb）和血细胞比容（HCT）的变化。
术后1天和3天的Hb和HCT较术前显著改善（<0.01）。然而，两组间差异无统计学意义（>0.05）。两组间失血量、术后引流量、总失血量、术中失血量、隐性失血量、术后引流时间及输血率比较，差异均无统计学意义（>0.05）。两组均未发生静脉血栓形成及不良事件。
在腰椎减压融合术围手术期，口服TXA与静脉注射TXA在减少围手术期失血量方面效果相同，且安全可靠。建议采用口服TXA以节省医疗费用并方便操作。
