大剂量氨甲环酸减少儿童早发性脊柱侧凸半椎体切除术中出血的临床研究

发布时间：2018-04-28 04:07

  本文选题：早发性脊柱侧凸 + 半椎体切除　； 参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]评价大剂量氨甲环酸(tranexamic acid, TXA)应用于儿童早发性脊柱侧凸患者的半椎体切除并后路融合手术中的安全性和有效性。[方法]从2013年2月到2017年3月之间在昆明医科大学第二附属医院骨科就诊的小于10岁的拟行单个半椎体切除并后路融合手术的早发性脊柱侧凸(early onset scoliosis,EOS)患者中筛选出69例纳入本研究。将入选本研究的患者随机分为应用大剂量TXA的TXA组和应用等量生理盐水的对照组。TXA组包含35个病例,使用100mg/kg负载量和10mg/kg/h维持量的TXA,对照组包含34个病例,使用和TXA组相同剂量方案的生理盐水。所有患者的手术都在同一主刀医生和同一麻醉医师的协作下完成,所有患者均行单个半椎体切除,其中小于3岁的患者行2个节段的脊柱融合,而大于3岁的患者根据畸形的程度分别进行2～7个节段的融合。统计术中出血量、真实出血量(出血量/血容量× 100% )和术中输血量来评价TXA的有效性;统计相关并发症,包括肝肾功能损害、深静脉血栓形成(deep venous thrombosis,DVT)、急性心肌梗死(acute myocardial Infarction, AMI)、肺栓塞、心律失常和癫痫来评价TXA的安全性。[结果]①两组患者在性别、年龄、体重、血容量、融合节段数及手术时间方面无统计学差异(P0.05);分别比较两组中≤3岁、3～6岁和≥6岁患者的上诉指标,也均无统计学差异(P0.05)。②TXA组的术中出血量[(385±181) ml]、真实出血量[(26.1±9.6)%]都显著小于对照组[分别为(588±171) ml, (40.5±7.6) %,均 P0.05]。③ TXA组较对照组有着更少的术中输血量[(349±141) ml比(495±177) ml,P 0.05]。④TXA组中≤岁、3～6岁和≥6岁的患儿的术中出血量、真实出血量和术中输血量都显著少于对照组中相应≤岁、3～6岁和≥6岁的患儿(P0.05)。⑤TXA组和对照组相比,术前及术后一天的血红蛋白、红细胞压积、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、国际标准化比值(INR)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)和血肌酐(SCr)的检验值以及术中尿量均无统计学差异(P0.05) ; TXA组和对照组中≤岁、3～6岁和≥6岁患儿的上诉指标也均无统计学差异(P0.05) 。⑥两组的所有患者中都没有出现DVT、AMI、肺栓塞和癫痫等相关并发症。[结论]大剂量氨甲环酸能够有效减少儿童早发性脊柱侧凸患者半椎体切除手术中的出血量和输血量,并且是安全的。
[Abstract]:[objective] to evaluate the safety and efficacy of high dose tranexamic acid (TXA) in hemivertebra resection and posterior fusion in children with early scoliosis. [methods] from February 2013 to March 2017, patients under 10 years old who were admitted to the Department of Orthopaedics, second affiliated Hospital of Kunming Medical University, undergoing single hemivertebra resection and posterior fusion surgery, were diagnosed with early onset scoliosissis (EOS) patients with middle sieve. 69 cases were selected to be included in this study. The patients in this study were randomly divided into two groups: the TXA group with high dose of TXA and the control group with the same amount of normal saline. The patients in the TXA group were treated with 100mg/kg load and 10mg/kg/h maintenance, while the control group consisted of 34 cases. Use the same dosage of saline as the TXA group. All patients underwent surgery in collaboration with the same surgeon and anesthesiologist. All patients underwent a single hemivertebra resection, with two segments of spinal fusion performed in patients younger than 3 years of age. Patients over 3 years of age were fused with 2 to 7 segments according to the degree of malformation. To evaluate the effectiveness of TXA by counting intraoperative bleeding volume, real bleeding volume (bleeding volume / blood volume 脳 100%) and blood transfusion volume during operation, the related complications, including liver and kidney dysfunction, were analyzed. Deep venous thromboplasms were used to evaluate the safety of venous, acute myocardial intervention, AMI, pulmonary embolism, arrhythmia and epilepsy. [results] 1There was no significant difference in sex, age, body weight, blood volume, number of fusion segments and operation time between the two groups (P 0.05). There was also no significant difference in intraoperative blood loss [385 卤181ml] and real blood loss (26.1 卤9.6%) in the P0.05TXA group, which were significantly lower than those in the control group (588 卤171ml, 40.5 卤7.6ml, P0.05). The blood transfusion volume in the TXA group was significantly lower than that in the control group (349 卤141ml vs 495 卤177ml, P 0.05). The amount of intraoperative blood loss in children with 鈮，

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