【摘要】 目的 :评估在颈椎管扩大椎板成形术(ELAP)中联合静脉和局部应用氨甲环酸(TXA)在减少术后失血量和加速康复(ERAS)方面的有效性和安全性。方法:通过回顾性队列研究,分析多节段脊髓型颈椎病行ELAP的患者共175例,其中男性127例,女性48例,年龄26～76岁,平均55.1±10.3岁。所有患者术中术后均使用静脉TXA,根据是否硬膜外局部应用TXA(1.0g),将患者分为观察组(102例,2019年10月～2020年9月)和对照组(73例,2019年1～9月)。收集两组人口统计学、术前血清学、术中和术后出血量、手术时间和住院时间、并发症(深静脉血栓、脑梗死、伤口血肿形成等)资料,评估TXA局部使用的有效性和安全性。结果:在人口统计学、术前血清学、手术时间和术中出血量方面,观察组和对照组的差异均没有统计学意义。与对照组相比,观察组术后第1天和第2天引流量明显少于对照组(42.1±32.1ml vs 52.5±35.0ml,P=0.017;23.2±32.5ml vs 42.0±34.9ml,P<0.001)。观察组围术期引流时间较短(1.6±0.8d vs 2.1±0.8d,P<0.001)、术后住院时间较短(3.3±1.2d vs 4.2±1.1d,P<0.001)。术后两组均未见与TXA相关的并发症。结论:颈椎管扩大椎板成形术中联合静脉和硬膜外局部应用TXA给药可减少围术期出血量,缩短术后住院时间,并且不会增加血栓相关并发症发生率。更多还原

【Abstract】 Objectives: To evaluate the efficacy and safety of combined intravenous and epidural local application of tranexamic acid(TXA) in reducing postoperative blood loss and accelerating recovery after cervical expansive laminoplasty(ELAP). Methods: In this retrospective cohort study, 175 patients with multilevel cervical spondylotic myelopathy underwent ELAP. There were 127 males and 48 females, aged from 26 to 76 years old, with an average of 55.1±10.3 years old. All these patients had intravenous TXA administration, and were divided into observation group(n=102, October 2019 to September 2020) and control group(n=73, from January to September, 2019) depending on whether applying TXA(1.0 g) locally during the surgery. The follow-ing data were collected, including demographic profiles, preoperative hematologic data, intraoperative and post-operative blood loss, operating time and length of hospital stay, and complications(deep vein-thrombosis, cere-bral infarction and wound hematoma). Results: There were no statistically significant differences in demographics, preoperative haematologic data, the operation time and intraoperative blood loss. Postoperative blood loss during the 1 st and 2 nd day after operation was reduced significantly in the observation group compared with that of the control group(42.1±32.1 ml vs 52.5±35.0 ml, P=0.017; 23.2±32.5 ml vs 42.0±34.9 ml, P<0.001).The perioperative drainage time of the observation group was less(1.6 ±0.8 days vs 2.1±0.8 days, P<0.001)with shorter postoperative hospital stay(3.3±1.2 days vs 4.2±1.1 days, P<0.001). No major intraoperative complications related to hematoma and thrombosis was observed. Conclusions: Combined intravenous administration and local epidural application of tranexamic acid could safely reduce postoperative blood loss and shorten the hospital stay with accelerating recovery after cervical ELAP.更多还原