| Background:Spinal surgery usually has large trauma and is prone to bleeding.Perioperative massive bleeding can cause patients with mortality,surgical complications,reoperation rate and infection rate.Therefore,how to reduce bleeding in the perioperative period is a hot topic in spinal surgery.In recent years,studies have shown that the use of the antifibrinolytic drug tranexamic acid can reduce the amount of trauma and perioperative blood loss,as well as the blood transfusion rate and mortality caused by bleeding.In clinical use,if intravenous infusion of tranexamic acid is administered,and some drugs gathered in the surgical and traumatic areas after about 15 min to exert hemostatic effect,and the incidence of venous thrombosis may also be increased due to the antifibrinolytic effect of tranexamic acid in the vascular.However,topical application can reduce the incidence of venous thrombosis.Some studies have shown that in hip and knee replacement surgery,the perioperative blood loss of patients with topical application of tranexamic acid is significantly lower than that of patients with intravenous application of tranexamic acid.At present,there are few studies comparing the hemostatic effect of topical application of tranexamic acid with intravenous application of tranexamic acid under spinal surgery conditions,and the influence of different administration routes on the incidence of lower extremity venous thrombosis.In this study,the effect of local application of tranexamic acid on coagulation and fibrinolytic function and bleeding volume in spinal surgery was discussed,so as to provide references for rational use of tranexamic acid in clinical practice and further optimize the utilization of medical resources.Objective:To observe the effects of topical application and intravenous tranexamic acid on postoperative bleeding volume and coagulation and fibrinolysis in patients undergoing spinal surgery.Methods:A total of 96 patients who underwent multi-stage and thoracolumbar posterior bone grafting and fusion internal fixation in the department of spinal surgery of our hospital from October 2017 to October 2018 were randomly divided into 4 groups: Control group(Before suturing the deep fascia,soak 0.9% normal saline 100ml),intravenous infusion group((intravenous infusion of 1% tranexamic acid injection 100 ml 30min after the operation),0.5% tranexamic acid group(Before suturing the deep fascia,soak 0.9% normal saline 50ml+1% tranexamic acid injection 50ml)and 1% tranexamic acid group(Before suturing the deep fascia,soak 1% tranexamic acid injection 100ml),each group had 24 cases.The intraoperative blood loss of each group was measured,and the incision drainage volume at the first,second and third day after the operation was measured.Before and on the first,second and third days after surgery,Hemoglobin(Hb),Hematocrit(Hct),Platelet(PLT)and Five coagulation tests were determined.The d-dimer(D-D)level was determined by immunoturbidimetry.Tissue plasminogen activator(t-pa)and plasminogen activator inhibitor(pai-1)were detected by ELISA.TEG indicators are tested.B-ultrasound examination of both lower limbs was performed 3rd day after operation.Results:1.General situationthere were no statistically significant differences in gender,age,weight and height between the 4 groups(P>0.05).2.Intraoperative blood loss and postoperative incision drainage volumeIntraoperative blood loss: there was no statistically significant difference in intraoperative blood loss between the groups(P>0.05).Postoperative incision drainage volume: On the first,second and third days after the surgery,the drainage of the intravenous drip group,0.5% tranexamic acid group and 1% tranexamic acid group was less than that of the control group at the same time(P<0.05);the drainage of the 1% tranexamic acid group was less than 0.5% tranexamic acid group and intravenous drip group(P<0.05);the drainage of 0.5% tranexamic acid group was not statistically significant different from that of the intravenous drip group(P > 0.05).The drainage volume gradually decreased on the first,second and third days after surgery in the 4 groups(P<0.05).3.Hemoglobin,hematocrit,plateletHb and Hct: there was no statistically significant difference between the groups before operation(P>0.05).On the 1st,2nd and 3rd day after the operation,Hb and Hct of intravenous infusion group,0.5% tranexamic acid group and 1% tranexamic acid group were all higher than that of the control group(P<0.05).On the first day after surgery,1% tranexamic acid group was higher than 0.5% tranexamic acid group and intravenous infusion group(P<0.05).There was no significant difference in Hb and Hct between the 0.5% tranexamic acid group and the intravenous infusion group(P>0.05).PLT: there was no significant difference between the groups at the same time point(P>0.05).4.Five coagulationThere was no significant difference in APTT,PT,TT,FIB and INR at different time points between and within each group(P>0.05).5.TEG test resultsOn the first day after the surgery,MA of the intravenous infusion group,0.5% tranexamic acid group and 1% tranexamic acid group was higher than that of the control group(P<0.05),MA of the 1% tranexamic acid group was higher than that of the intravenous infusion group and 0.5% tranexamic acid group(P<0.05),and there was no statistically significant difference between the 0.5% tranexamic acid group and the intravenous infusion group(P>0.05).On the second and third days after surgery,there was no statistically significant difference in MA between the groups(P>0.05).There were no statistically significant differences in R,K,Angle and LY30 between the 4 groups and at different time points within the group(P>0.05).6.D-DOn the first,second and third days after the surgery,the d-d levels of the intravenous drip group,0.5% tranexamic acid group and 1% tranexamic acid group were lower than those of the control group(P<0.05),the d-d levels of the 0.5% tranexamic acid group and 1% tranexamic acid group were lower than those of the intravenous drip group(P<0.05),and the d-d levels of the 1% tranexamic acid group were the lowest(P<0.05).The d-d level reached the peak value on the first day after surgery in all the 4 groups,and then presented a gradually decreasing trend(P<0.05).7.t-PA?PAI-1There was no statistically significant difference in t-pa and PAI-1 between the 4 groups or at different time points within the group(P>0.05).8.B-ultrasound examinationB-ultrasound examination of both lower limbs of the 4 groups 3rd day after operation showed that DVT was not formed in popliteal vein,external iliac vein,tibial anterior vein and femoral vein.Conclusions:1.Topical application of tranexamic acid in spinal surgery patients can effectively reduce blood loss after spinal surgery,and will not increase the incidence of lower limb DVT formation.2.Under the same dosage,topical application of tranexamic acid in spinal surgery patients has better anti-fibrinolysis and hemostasis than intravenous application of tranexamic acid.3.Under the same dosage,topical application of 1%tranexamic acid in spinal surgery patients has better anti-fibrinolysis and hemostasis than topical application of 0.5%tranexamic acid. |
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