目的:研究氨甲环酸不同使用方式对行单节段后入路腰椎椎体融合术患者的影响。方法:将接受后入路腰椎椎体融合术(PLIF)治疗的患者90例分成A、B、C 3个组,每组各30例。A组在术前15 min静注100 mL氨甲环酸(TXA)溶液(15 mg/kg TXA:100 mL 0.9 %NaCl溶液),B组患者于缝合深筋膜前,用20 mL TXA溶液(1 g TXA:20 mL 0.9 %NaCl溶液)浸泡创面5 min,冲洗后单侧留置引流管,C组患者留置引流管后沿引流管向切口内注入20 mL TXA溶液(1 g TXA:20 mL 0.9 %NaCl溶液)。观察各组临床指标及术后并发症发生情况。结果:(1)血红蛋白与红细胞压积比较:术后1 d时A组高于B、C组(P＜0.05);术后3 d时C组高于A、B组(P＜0.05);(2)总失血量、术后引流量、隐性失血量比较:C组低于A、B两组(P＜0.05);(3)术中失血量比较:A组低于B、C组(P＜0.05);(4)术后1、3 d的D-二聚体、凝血五项比较:差异无统计学意义(P＞0.05);(5)术后并发症发生情况比较:差异无统计学意义(P＞0.05)。结论:行单节段PLIF术后的患者局部应用TXA联合引流管夹闭1 h的方式能减少患者围手术期总失血量、术后引流量和隐性失血量且安全性与传统静脉滴注相当,值得临床推广。

Objective: To study the effect of different use modes of tranexamic acid on patients undergoing single-segment posterior lumbar vertebral fusion. Methods: Ninety patients undergoing posterior lumbar interbody fusion (PLIF) were divided into groups A, B and C, with 30 patients in each group. Patients in group A were intravenously injected with 100 mL tranexamic acid (TXA) solution (15 mg/kg TXA: 100 mL 0.9 % NaCl solution) 15 min before operation. Patients in group B were soaked in 20 mL TXA solution (1 g TXA: 20 mL 0.9 % NaCl solution) for 5 min before suturing the deep fascia, and unilateral drainage tube was placed after washing. Patients in group C were injected with 20 mL TXA solution (1 g TXA: 20 mL 0.9 % NaCl solution) into the incision along the drainage tube. The clinical indexes and postoperative complications of each group were observed. Results: (1)Comparison of hemoglobin and hematocrit: those in group A were higher than those in group B and group C at 1 day after operation (P＜0.05); those in group C were higher than those in group A and group B at 3 days after operation (P＜0.05). (2)Comparison of total blood loss, postoperative drainage volume and hidden blood loss: those in group C were lower than those in group A and group B (P＜0.05). (3)Comparison of intraoperative blood loss: that in group A was lower than that in group B and group C (P＜0.05). (4) There was no significant difference in D-dimer and coagulation five items at 1 and 3 days after operation (P＞0.05). (5) There was no significant difference in postoperative complications among three groups(P＞0.05) . Conclusion: Topical application of TXA combined with drainage tube clamping for 1 h after single-segment PLIF can reduce the total perioperative blood loss, postoperative drainage and hidden blood loss in patients, and the safety is comparable to that of traditional intravenous drip, which is worthy of clinical promotion.