Hao Shenshen, Wang Xiangping, Yue Zenan, Zhang Ruijun, Wang Pengcheng, Meng Saike, Liu Shuai, Li Hongke, Dong Shengli
Department of Spine and Bone Oncology, General Hospital of Pingmei Shenma Medical Group, Pingdingshan, China.
Department of Anesthesia and Perioperative Medicine, General Hospital of Pingmei Shenma Medical Group, Pingdingshan, China.
Front Surg. 2023 Jan 6;9:1032376. doi: 10.3389/fsurg.2022.1032376. eCollection 2022.
Tranexamic acid (TXA) has been used in posterior lumbar interbody fusion (PLIF) and reduces blood loss. However, it has not been reported whether it will continue to affect postoperative red blood cells (RBC), hemoglobin (HB), hematocrit (HCT), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The purpose of this study was to observed the above indicators at different time after PLIF with unit dose intravenous (iv) TXA.
The data of 44 patients treated by single-segment PLIF from 2020.11 to 2022.3 were retrospectively analyzed. Observation group was given a unit dose of ivTXA (1 g/100 mL) 15 min before skin incision after general anesthesia. Patients without TXA were recorded as control group. Main observation indicators include RBC, HB, HCT, CRP and ESR on the 1st, 4th, 7th and last tested day after surgery. Secondary observation indicators include postoperative activated partial thrombin time (APTT), prothrombin time (PT), thrombin time (TT), and fibrinogen (FIB); and operation time, intraoperative blood loss, postoperative drainage volume, incision healing, postoperative deep vein thrombosis and postoperative hospital stay.
The operation was successfully completed without related complications. At term of main observation indicators, RBC, HB and HCT remained relatively stable, while CRP and ESR fluctuated to some extent after PLIF. The RBC, HB and HCT in the observation group were higher than those in the control group with statistically significant ( < 0.05). Except the CRP of 7th postoperative day of the observation group was significantly lower than that of the control group ( < 0.05), there was no difference in other CRP and ESR between the two groups ( > 0.05). At term of secondary observation indicators, the intraoperative blood loss and postoperative drainage volume of the observation group were lower than those of the control group with statistically significant ( < 0.05). There was no significant difference in postoperative APTT, PT, TT, FIB, and operation time and postoperative hospital stay between the two groups ( > 0.05).
The application of unit dose of ivTXA in PLIF can safely and effectively reduce blood loss. Meanwhile, it can also maintain higher RBC, HB, HCT levels without disturbing CRP and ESR levels after surgery.
氨甲环酸（TXA）已用于后路腰椎椎间融合术（PLIF）并减少失血。然而，尚未有报道其是否会持续影响术后红细胞（RBC）、血红蛋白（HB）、血细胞比容（HCT）、C反应蛋白（CRP）和红细胞沉降率（ESR）。本研究的目的是观察单剂量静脉注射（iv）TXA用于PLIF术后不同时间的上述指标。
回顾性分析2020年11月至2022年3月接受单节段PLIF治疗的44例患者的数据。观察组在全身麻醉后皮肤切开前15分钟给予单剂量ivTXA（1g/100mL）。未使用TXA的患者记录为对照组。主要观察指标包括术后第1天、第4天、第7天和最后一次检测日的RBC、HB、HCT、CRP和ESR。次要观察指标包括术后活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、凝血酶时间（TT）和纤维蛋白原（FIB）；以及手术时间、术中失血量、术后引流量、切口愈合情况、术后深静脉血栓形成和术后住院时间。
手术顺利完成，无相关并发症。在主要观察指标方面，PLIF术后RBC、HB和HCT保持相对稳定，而CRP和ESR有一定程度波动。观察组的RBC、HB和HCT高于对照组，差异有统计学意义（<0.05）。除观察组术后第7天的CRP显著低于对照组（<0.05）外，两组其他CRP和ESR无差异（>0.05）。在次要观察指标方面，观察组的术中失血量和术后引流量低于对照组，差异有统计学意义（<0.05）。两组术后APTT、PT、TT、FIB以及手术时间和术后住院时间无显著差异（>0.05）。
单剂量ivTXA应用于PLIF可安全有效地减少失血。同时，它还能在不干扰术后CRP和ESR水平的情况下维持较高的RBC、HB、HCT水平。
