Effects Of Different Application Of Tranexamic Acid On Reducing Blood Loss In Lumbar Spine Surgery

ObjectiveTo study the application of tranexamic acid(TXA),which is more effective and safe in posterior lumbar spine surgery,provides a clinical basis for reducing bleeding and speeding up postoperative recovery.MethodsA total of 118 patients with posterior lumbar spine surgery who underwent exclusion criteria from September 2016 to January 2019 were randomly assigned to the intravenous group(39 patients in group A),the local group(40 patients in group B),and the control group(39 patients in group C).The three groups were treated differently,In group A,20 mg/kg of TXA was added to 100 ml of normal saline intravenously 30 min before surgical incision,and the drip rate was controlled to be40-60 drops/min,then continuously instilled at a concentration of 2 mg/kg/h of TXA until the end of the operation.In group B,20 ml of 0.1g/ml TXA solution was sprayed to the oozing site one by one.After the main surgical procedure was completed,the10 ml TXA solution was poured into the operation cavity before the deep fascia wasclosed,and then the incision was tightly sutured layer by layer.After the drainage tube was clamped for 30 minutes,it was naturally drained.Group A and group B were also treated with physiological saline on the corresponding processing,respectively,and group C was trated with saline.To evaluate the age,gender,BMI index,ASA rating,duration of disease,BMD,surgical segment,preoperative coagulation and fibrinolysis,and other basic data of the three groups of patients,calculate the amount of bleeding during the operation(the total amount of liquid in the suction bottle+the net weight gain of gauze-flushing fluid volume),postoperative drainage,postoperative hemoglobin changes,fibrinolysis changes,blood transfusion rate and the occurrence of related complications to evaluate its applicability in lumbar spine surgery and the effect of different TXA application methods.ResultThere were no significant differences in the general basic data of age,gender,BMI,ASA,duration of disease,BMD,surgical segment,and preoperative coagulation and fibrinolysis indicators among the three groups(P>0.05).The intraoperative blood loss of the group A and the group B(300.11±58.78 ml,379.87±67.96 ml)was significantly different from the group C(489.93±73.67 ml)(P<0.05),and there was less bleeding in the group A(P<0.05).The postoperative drainage volume of the group A(270.04±55.95ml)and the group B(199.98±50.14ml)was significantly different from the group C(329.74±61.81ml)(P<0.05),and the drainage volume of group B was less than that of the group A(P<0.05).The detection values of fibrinolytic indicators D-D and FDP in the three groups were significantly higher than those in the first 12 hours after operation(P<0.05),and the detection values in the group A and the group B were lower than those in the group C(P<0.05),but there was no significant difference between group A and group B(P>0.05).The transfusion rates of group A(7%)and group B(5%)was lower than those of group C(23%),and the difference between group A and B was not statistically significant(P>0.05).There was no significant difference in the number of complications between the three groups during treatment(P>0.05).Conclusion1.In this study,Intravenous and topical application of TXA can effectively reduce the blood loss during and after lumbar posterior surgery and reduce the blood transfusion rate.The application of TXA in intravenous administration has better effect of haemostasis during the operation.Local application of TXA in reducing postoperative drainage fluid Better than intravenous application.2.In this study,Preoperative load(20mg/kg)plus intraoperative continuous irrigation(2mg/kg/h)TXA intravenous use and(0.1g/ml,30ml)TXA local spray and short-time soaking usage did not increase the incidence rate of associated concurrency complication.3.Lumbar posterior surgery has "hidden bleeding",the application of TXA can improve the postoperative fibrinolysis.