| 刘红正,郜顺兴,张楠.不同负压引流方式联合氨甲环酸对颈椎后路单开门手术病人失血量、引流量及并发症的影响[J].安徽医药,2024,28(5):920-924. |
| 不同负压引流方式联合氨甲环酸对颈椎后路单开门手术病人失血量、引流量及并发症的影响 |
| Effects of different negative pressure drainage methods combined with tranexamic acid on blood loss, drainage volume and complications in patients with posterior cervical single-door surgery |
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| DOI：10.3969/j.issn.1009-6469.2024.05.015 |
| 中文关键词: 颈椎 椎管 持续负压引流 颈椎后路单开门手术 氨甲环酸 凝血酶原时间 间断负压引流 |
| 英文关键词: Cervical vertebrae Spinal canal Continuous negative pressure drainage Posterior cervical single-door surgery Tranexamic acid Prothrombin time Intermittent negative pressure drainage |
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| 中文摘要: |
| 目的探究不同负压引流方式联合氨甲环酸对颈椎后路单开门手术的多节段脊髓型颈椎病病人失血量、引流量及并发症的影响。方法按照研究目标设定的纳入、排除标准，将 2018年 10月至 2020年 10月沧州中西医结合医院接受颈椎后路单开门手术的多节段脊髓型颈椎病病人 182例作为研究对象进行回顾性研究，根据负压引流情况分为 A组(持续负压引流联合氨甲环酸， 46例)、 B组(间断负压引流联合氨甲环酸， 46例)、 C组(持续负压引流，不使用氨甲环酸， 45例)及 D组(间断负压引流，不使用氨甲环酸， 45例)。对比四组病人手术时间、总失血量、术后引流量、术后 72 h血红蛋白水平，生化指标［活化部分凝血活酶时间( APTT)、凝血酶原时间( PT)、纤维蛋白原( Fib)］术后疼痛视觉模拟评分( VAS)及日本骨科协会评估治疗分数(JOA)评分。结果手术后，四组手术时间、总失血量比较差异，无统计学意义( P>0.05)四组术后 24 h引流量［ A组( 191.21±22.38)mL、B组(175.34±17.85)mL、C组(205.62±20.78)mL、D组( 210.43±20.14)mL］、术后失血量［ A组(275.37±30.12)mL、B组( 251.42±26.12)mL、C组( 321.47±35.62)mL、D组( 296.78±32.14)mL］、引流管留置时间［ A组( 1.85±0.51)d、B组( 1.45±0.42)d、 C组( 2.32±0.65)d、D组( 2.78±0.78)d］比较差异有统计学意义( P<0.05)，其中 B组最优，其次为 A组。四组术后 72 h血红蛋白水平［ A组( 112.43±12.57)g/L、B组( 120.53±17.85)g/L、C组( 103.47±10.78)g/L、D组( 102.58±11.12)g/L］均明显降低( P<0.05)，但是 B组下降最少，其次为 A组。四组血清 APTT、PT、Fib水平差值比较差异有统计学意义( P<0.05)，其中 A组各指标变化最明显， B组血清 APTT水平变化最小；四组 VAS评分与 JOA评分比较差异无统计学意义( P>0.05)；四组发热、脑脊液漏、血肿压迫脊髓、下肢深静脉血栓、心血管事件等并发症发生情况比较差异无统计学意义( P>0.05)。结论颈椎后路单开门手术中应用间隐性，断负压引流联合氨甲环酸利于手术时间缩短，并减少术后引流量及隐性失血量，改善血红蛋白水平。 |
| 英文摘要: |
| Objective To explore the effect of different negative pressure drainage methods combined with tranexamic acid on theblood loss, drainage volume and complications of multisegmental cervical spondylotic myelopathy patients undergoing posterior cervi-cal single-door surgery.Methods According to the inclusion and exclusion criteria set by the research objectives, a total of 182 pa-tients of multisegmental cervical spondylotic myelopathy, who underwent cervical posterior single door operation in Cangzhou Hospitalof Integrated Traditional and Western Medicine from October 2018 to October 2020, were selected as research subjects for a retrospec-tive study. They were assigned into group A (continuous negative pressure drainage combined with tranexamic acid, 46 cases), group B(intermittent negative pressure drainage combined with tranexamic acid, 46 cases), group C (continuous negative pressure drainagewithout using tranexamic acid, 45 cases) and group D (intermittent negative pressure drainage without using tranexamic acid, 45 cases)according to the negative pressure drainage. The operation time, total blood loss, postoperative drainage volume, 72 h postoperative he-moglobin level, biochemical indexes [activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (Fib)], postopera-tive pain visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score were compared among the four groups.Re. sults After the operation, there were no significant differences in the operation time and total blood loss among the 4 groups (P>0.05).Drainage volumes at 24 hours after operation [group A: (191.21±22.38) mL, group B: (175.34±17.85) mL, group C: (205.62±20.78) mL,group D: (210.43±20.14) mL], postoperative hidden blood loss [group A: (275.37±30.12) mL, group B: (251.42±26.12) mL, group C:(321.47±35.62) mL, group D: (296.78±32.14)mL], and indwelling time of drainage tube [group A: (1.85±0.51) d, group B: (1.45±0.42)d, group C: (2.32±0.65) d, group D: (2.78±0.78) d] were found to be statistically different (P<0.05), among which group B was the best,followed by group A. The hemoglobin levels at 72 hours after operation in all groups [group A: (112.43±12.57) g/L, group B: (120.53±17.85) g/L, group C: (103.47±10.78) g/L, group D: (102.58±11.12) g/L] were significantly decreased (P<0.05), with group B droppingthe least, followed by group A. The differences in serum APTT, PT and Fib levels among the four groups were statistically significant (P <0.05), among which the changes of all indicators in group A were the most obvious, and the serum APTT level in group B changed theleast. There were no significant differences in VAS and JOA scores among the four groups (P>0.05). And there were no significant dif-ferences in fever, cerebrospinal fluid leakage, hematoma compression, deep vein thrombosis of lower extremities, cardiovascular eventsand other complications among the four groups (P>0.05).Conclusion The application of intermittent negative pressure drainage com-bined with tranexamic acid in posterior cervical single door surgery can shorten the operation time, reduce the postoperative drainagevolume and hidden blood loss, and improve the hemoglobin level. |
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