| Objective(s):Skull base tumor is one of the common diseases in neurosurgery,craniotomy is the main treatment for these diseases.Craniocerebral surgery site is special,blood supply is rich,the operation time is long,the potential of intraoperative blood loss is large is its main characteristics.Massive blood loss leads to high complications and mortality,which seriously affects the prognosis of patients.Therefore,it is very important to take blood protection measures to reduce blood loss during the operation.Hemostatic agents are common ways of drug intervention.The mechanism of tranexamic acid action is different from that of haemocoagulase agkistrodon,but their safety and efficacy have been confirmed in clinical practice and have been widely used in clinical anesthesia.The application of these two drugs in neurosurgery is relatively less in general,and currently they are mostly used for perioperative hemostasis of craniocerebral trauma.The purpose of this study was to investigate the hemostatic effect of tranexamic acid and haemocoagulase agkistrodon in patients undergoing selective resection of skull base tumor and its effect on coagulation function.Methods:A total of 60 patients who were to undergo selective craniotomy for craniocerebral base tumor resection were selected and randomly divided into three groups by computer random number table method:tranexamic acid group(group T),haemocoagulase agkistrodon group(group H)and blank control group(group N),with 20 patients in each group.All the patients in the three groups received intravenous inhalation combined anesthesia.After anesthesia induction and arteriovenous puncture,2ml of non-clotting blood was extracted through the central venous catheter,and real-time coagulation function was analyzed by sonoclot coagulation and platelet function analyzer.Intravenous infusion of tranexamic acid(20mg/kg)or haemocoagulase agkistrodon(2U)20 minutes before the surgeon started the operation,and the same dose of normal saline was given to the blank control group.At the beginning of the operation,the autologous blood recovery device was connected to recover the blood lost during the operation.After the operation,the sonoclot coagulation and platelet function analyzer was used again to monitor the coagulation function of the patient at this time.Three groups of patients with surgery anesthesia doctors are of the same group,the influsion quantity including physiological requirements,lack of the cumulative dose,Compensatory capacity expansion(5 ml/kg),intraoperative blood loss,physiological requirements using the 4-2-1 rules,types of infusion choose compound electrolyte injection and succinyl gelatin,according to the crystal glue than 2:1 infusion,adjust infusion speed according to urine volume and blood loss at any time,and maintain a stable heart rate and blood pressure.Blood gas analysis was carried out intermittently during the operation to maintain the balance of water,electrolyte,acid and base.Prothrombin time(PT),partial thrombin activity time(APTT),fibrinogen(FIB),thrombin time(TT),platelet count(PLT),and hemoglobin count(Hb)were recorded for each patient at 24 hours before and after surgery.Preoperative and postoperative monitoring indicators of sonoclot coagulation and platelet function analyzer were recorded,including coagulation activation time(ACT)and coagulation rate(CR).The amount of incoming and outgoing(blood loss,autologous blood transfusion,allogeneic blood transfusion,urine,infusion)and postoperative 24 hours of drainage were recorded.Patients were followed up and their postoperative complications were recorded for 24 hours.Results:1.There was no statistically significant difference in general conditions among the three groups.2.There was no statistically significant difference in the preoperative and postoperative conventional coagulation indexes PT,APTT,FIB,TT and the monitoring indexes ACT and CR of the sonoclot coagulation and platelet function analyzer among the three groups(P>0.05);The postoperative platelet count(PLT)and hemoglobin count(Hb)of the three groups decreased compared with those before the operation(P<0.05),but there was no statistically significant difference between the groups(P>0.05).3.The intraoperative blood loss,autologous blood transfusion and postoperative 24-hour drainage volume of patients in group T and group H were all reduced compared with those in group N,with statistically significant differences(P<0.05),while there was no statistically significant difference between group T and group H(P>0.05);The allogeneic blood transfusion rate of T group and H group was lower than that of N group,and the difference between H group and N group was statistically significant(P<0.05),there was no statistically significant difference between group T and group N,group T and group H(P>0.05).4.There were no complications such as lower limb deep vein thrombosis,pulmonary embolism,epilepsy,and acute liver and kidney function injury.Conclusion(s):1.The hemostatic effect of tranexamic acid and haemocoagulase agkistrodon under single load dose in skull base tumor resection was similar,the two did not increase the incidence of postoperative thrombus events,nor did they affect the coagulation function of patients.The clinical efficacy and safety of different drug doses and use methods need to research with larger clinical sample size.2.Hemostatic drugs combined with autologous blood transfusion technology can reduce the perioperative blood transfusion rate of craniocerebral tumor surgery.Both of them are commonly used means in the current blood protection strategies,and their safety and feasibility have been confirmed,which are worthy of clinical application.3.sonoclot coagulation and platelet function analyzer is easy to operate and less time-consuming,which can timely reflect the coagulation status of perioperative patients.It can not only be used for perioperative bleeding management,but also guide clinical drugs and blood transfusion treatment,which has certain clinical significance. |
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