Analysis Of Risk Factors Of Hidden Blood Loss And Evaluation Of The Efficacy Of Tranexamic Acid In PEID Surgery

Lumbar disc herniation often causes sciatica.The typical clinical manifestation is radiation pain from the waist to the lower extremities,often accompanied by sensory or motor disorders.Open lumbar discectomy is usually performed in the early stage.With the development of endoscopic technology,endoscopic discectomy is more and more widely used in spinal surgery.Percutaneous endoscopic discectomy is one of the commonly used minimally invasive operations for the treatment of lumbar disc herniation.For L5-S1 segments,percutaneous endoscopic interlaminar discectomy(PEID)is more common at present.The actual amount of blood loss observed in PEID surgery is less,but the hemoglobin of some patients decreased significantly after operation,and even showed anemia,especially in elderly patients.And the PEID operation is performed under endoscope through the working channel of the interlaminar space under continuous saline irrigation.High-quality visual clarity is one of the key factors for the safety and success of endoscopic surgery.A small amount of bleeding during operation will complicate the operation process and prolong the operation time.At present,there is no related research on perioperative HBL of PELD at home and abroad.Therefore,the study of the risk factors of HBL after PEID can provide guidance for reducing blood loss and promoting postoperative rehabilitation.Through the discovery of relevant risk factors,we can further control the controllable factors and reduce perioperative bleeding.As an antifibrinolytic drug,TXA inhibits the binding of fibrin and plasminogen by reversibly competitive binding with lysine binding sites on plasminogen,thus increasing fibrinogen relatively.TXA can significantly reduce perioperative blood loss.In our previous study,we found that the use of TXA in posterior lumbar interbody fusion can significantly reduce perioperative blood loss,and no related complications were found.However,the efficacy and safety of TXA in PEID surgery are not clear.In this study,TXA was added to the saline-irrigation during PEID surgery to determine whether local application of TXA in PEID surgery can reduce hidden blood loss and shorten the operation time.Part One--Analysis of risk factors of hidden blood loss during percutaneous endoscopic interlaminar discectomyObjective:To preliminarily explore the relationship between hidden blood loss(HBL)and risk factors in percutaneous endoscopic interlaminar discectomy(PEID).Methods:A retrospective analysis of 113 patients with lumbar disc herniation(L5-S1 level)who underwent PEID with complete clinical data in the department of spinal surgery from January 2018 to August 2020,including 67 males and 46 females,age 21-71 years old.The data collected included general patient indicators(age,body mass index and gender),underlying diseases(hypertension and diabetes),laboratory tests(prothrombin time,activated partial thromboplastin time,fibrinogen,hematocrit and hemoglobin level),imaging related parameters(grade of intervertebral disc degeneration,interlaminar space height and soft tissue thickness of interlaminar approach),intraoperative significant blood loss and operation time.According to the Gross formula,total blood loss and HBL during operation were calculated.Results:The total perioperative blood loss was(394.85±130.50)mL,and HBL was(337.09 ±124.98)mL which accounting for 85.4%of total blood loss.Multivariate linear regression analysis showed that operation time(P<0.001)and disc degeneration grade(P=0.020)were independent risk factors of HBL.Conclusion:HBL is the main cause of blood loss during PEID,and operation time and disc degeneration grade are independent risk factors that affect the amount of hidden blood loss.Part Two--The efficacy and safety of topical saline-irrigation with tranexamic acid on perioperative blood loss in patients treated with PEIDObjective:To evaluate the efficacy and safety of tranexamic acid(TXA)in the treatment of perioperative blood loss in patients with PEID.Methods:L5-S1 segmental LDH patients undergoing PEID surgery were divided into two groups(TXA group and control group)according to whether TXA was added to the surgical saline-irrigation.All PEID operations were performed by the same spinal surgery team.The general clinical data of the patients were collected,and the HBL,intraoperative blood loss,total blood loss,amount of fluid used,operation time,visual clarity,hospital stay,blood transfusion rate,blood coagulation index and the incidence of complications were compared between the two groups.Results:The TBL,HBL and IBL in the TXA group were lower than those of the control group.The postoperative hemoglobin in the TXA group was higher than that of the control group.Visual clarity was better and operation time was shorter in the TXA group.However,there was no significant difference in postoperative hematocrit,blood coagulation function,amount of fluid used,blood transfusion rate and perioperative complications between the two groups.Conclusion:In PEID surgery,addition TXA to topical saline-irrigating fluid can reduce HBL,IBL and TBL.Addition TXA to topical saline-irrigating fluid can improve visual clarity in the surgery and reduce operation time,but do not change coagulation function or increase complication rate.