Effect of adding tranexamic acid during surgery on blood loss and security during short segment lumbar spinal ste-nosis surgery
Objective To discuss the effect of adding tranexamic acid(TXA)during surgery on blood loss and security during short segment lumbar spinal stenosis surgery.Methods One hundred and eight patients with lumbar spinal stenosis who were to undergo lumbar posterior fusion surgery were randomly divided into control group,TXA group and adding TXA group,with 36 patients in each group.In the control group,TXA was not used during surgery.The TXA group received in-travenous infusion of 100 mL normal saline mixture containing 1 g of TXA 15 minutes before surgery after anesthesia.In adding TXA group,after the same operation in TXA group,10 mg/kg(body weight)of TXA was infused 3 hours later.Total perioperative blood loss,dominant blood loss,hidden blood loss,intraoperative blood loss,postoperative drainage volume,and transfusion rate were recorded in the two groups.Hemoglobin(Hb),hematocrit(HCT),prothrombin time international standardized ratio(PT-INR),prothrombin time(PT),activated partial thromboplastin time(APTT),blood platelet count(BPC),D-dimer(D-D),fibringen(FIB),C-reactive protein(CRP),alanine aminotransferase(ALT),blood urea nitro-gen(BUN)were measured 3 days before and after the surgery in the three groups.Postoperative adverse events were fol-lowed up.Results The total blood loss(mL)[(968.7±209.6)vs(1 369.8±276.3),(968.7±209.6)vs(1 273.9± 250.2)],dominant blood loss(mL)[(590.5±164.3)vs(876.4±235.9),(590.5±164.3)vs(789.3±221.7)],intraoper-ative blood loss(mL)[(318.7±120.7)vs(457.8±146.6),(318.7±120.7)vs(423.9±162.3)]and postoperative drainage volume(mL)[1 day after surgery:(164.6±25.0)vs(262.3±51.7),(164.6±25.0)vs(219.8±37.1);3 days after surger-y:(107.2±18.6)vs(156.3±37.6),(107.2±18.6)vs(145.3±22.3)]of the adding TXA group were lower than those of the control group and TXA group(P＜0.05),and the transfusion rate was lower than that of the control group(P＜0.05).The postoperative drainage volume and transfusion rate of TXA group were lower than that of the control group(P＜0.05).There was no statistical difference in the amount of hidden blood loss between the three groups(P＞0.05).Compared with the preoperative results,Hb,Hct and BPC in the three groups decreased(P＜0.05),and D-D,FIB and CRP increased(P＜0.05),but the change degree of Hb,Hct,BPC,D-D and CRP in the TXA group and the adding TXA group was less than that in the control group(P＜0.05),and the change degree of Hb,Het,BPC,D-D and CRP in the adding TXA group was less than that in the TXA group(P＜0.05).There was no statistically significant difference in PT-INR,PT,APTT,ALT and BUN between and within the three groups before and after surgery(P＞0.05),and all of them were within the normal range.No serious adverse events such as deep vein thrombosis,pulmonary embolism,epilepsy,liver and kidney damage were found in all patients after postoperative follow-up.Conclusion Intraoperative addition of TXA can effectively reduce the a-mnount of blood lost during short segment lumbar spinal stenosis surgery without increasing the risk of complications such as coagulation disorders,thrombosis,liver and kidney function damage.
万方数据
维普
