全程出血管理在退变性腰椎管狭窄症围手术期的应用
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摘要
目的观察全程出血管理对退变性腰椎管狭窄症围手术期患者术中出血量、术后引流以及术后输血的影响,探讨该病围手术期减少出血的有效方法。方法将2014年1月至2015年8月广州市番禺区中医院收治的66例退变性腰椎管狭窄症患者,采用单盲分组,随机分为试验组(32例)和对照组(34例),试验组采取围手术期全程出血管理模式,对照组给予常规血液管理模式。比较两组患者手术时间、术中失血量、术后引流量及输血情况。结果试验组手术时间、术中失血量、术后引流量、输血例数、输血量均低于对照组,术后3 d血红蛋白、红细胞比积均高于对照组,两组比较,差异具有统计学意义(P<0.05)。结论退变性腰椎管狭窄症围手术期采用全程出血管理可有效减少术中失血量和术后引流量,降低输血量和输血比率,有利于患者术后恢复。
Objective To explore the influence of whole-course bleeding management on intraoperative blood loss, postoperative drainage and blood transfusion of patients with degenerative lumbar spinal stenosis, and to explore the effective methods to reduce perioperative bleeding. Methods A total of 66 patients with degenerative lumbar spinal stenosis treated in Panyu Hospital of Traditional Chinese Medicine from January 2014 to August 2015 was selected, and divided into experimental group(32 patients) and control group(34 patients)by using single-blind stochastic method. Whole-course bleeding managment were carried out during the perioperative period for patients in experimental group, while patients in control group were given traditional blood management. Operation time, intraoperative blood loss, postoperative drainage volume and blood transfusion conditions were compared between two groups. Results Operation time, intraoperative blood loss,postoperative drainage volume, cases of blood transfusion as well as transfusion volume in experimental group were lower than those in control group, levels of hemoglobin and hematocrit in experimental group 3 d after the surgery were higher than those in control group, the differences between two groups had statistical significance(P <0.05). Conclusion Application of whole-course blood management during perioperative period for degenerative lumbar spinal stenosis could effectively decrease the intraoperative blood loss and postoperative drainage volume, and reduce blood transfusion rate and transfusion volume, which promotes the rehabilitation of postoperative patients.
Objective To explore the influence of whole-course bleeding management on intraoperative blood loss, postoperative drainage and blood transfusion of patients with degenerative lumbar spinal stenosis, and to explore the effective methods to reduce perioperative bleeding. Methods A total of 66 patients with degenerative lumbar spinal stenosis treated in Panyu Hospital of Traditional Chinese Medicine from January 2014 to August 2015 was selected, and divided into experimental group(32 patients) and control group(34 patients)by using single-blind stochastic method. Whole-course bleeding managment were carried out during the perioperative period for patients in experimental group, while patients in control group were given traditional blood management. Operation time, intraoperative blood loss, postoperative drainage volume and blood transfusion conditions were compared between two groups. Results Operation time, intraoperative blood loss,postoperative drainage volume, cases of blood transfusion as well as transfusion volume in experimental group were lower than those in control group, levels of hemoglobin and hematocrit in experimental group 3 d after the surgery were higher than those in control group, the differences between two groups had statistical significance(P <0.05). Conclusion Application of whole-course blood management during perioperative period for degenerative lumbar spinal stenosis could effectively decrease the intraoperative blood loss and postoperative drainage volume, and reduce blood transfusion rate and transfusion volume, which promotes the rehabilitation of postoperative patients.
引文
[1]冯锡光,张敏,唐俊,等.退变性腰椎管狭窄症不同手术方案疗效对比[J].中国骨科临床与基础研究杂志,2015,7(1):40-43.
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[7]董小雄,王永宏,张洪师,等.后路有限减压Dynesys动态固定治疗腰椎管狭窄症的早期临床疗效[J].中国骨科临床与基础研究杂志,2015,7(4):203-207.
[8]李丽彬,李桂焕,李智斐,等.退行性腰椎管狭窄症选择性椎板减压术后下床时间对其疗效的影响[J].广东医学,2010,31(23):3152-3154.
[9]林定坤,陈树东,苏国义,等.经肌间隙入路经椎间孔腰椎椎体间融合术并椎管潜行减压治疗腰椎管狭窄症[J].广东医学,2013,34(15):2336-2339.
[10]行勇刚,田伟,何达,等.经皮椎间孔镜治疗腰椎神经根孔狭窄的短期疗效观察[J].中国微创外科杂志,2016,16(5):445-448.
[11]禤天航,曹正霖,关宏刚,等.PELD与TLIF治疗腰椎间盘突出症并神经根管狭窄疗效比较[J].现代中西医结合杂志,2015,24(28):3085-3088.
[12]解京明,李韬,王迎松,等.大剂量氨甲环酸用于脊柱矫形手术的安全性和有效性[J].中国脊柱脊髓杂志,2016,26(1):48-54.
[13]杨元生,陈垦,石星亮,等.促红细胞生成素的临床应用进展[J].中华全科医学,2009,7(9):992-994.
[14]苏暄.快速康复关节外科的"独家"血液管理策略[J].中国医药科学,2015,5(8):1-3.
[15]解冰,田竞,杨超,等.重组人促红细胞生成素对降低老年股骨粗隆间骨折围手术期输血的病例对照研究[J].中国骨伤,2015,28(7):633-637.
[16]王健,杨伟胤,王可良.脊柱手术静脉应用氨甲环酸减少出血的荟萃分析[J].实用医学杂志,2015,31(2):279-282.
[17]Soni A,Saini R,Gulati A,et al.Comparison between intravenous and intra-articular regimens of tranexamic acid in reducing blood loss during total knee arthroplasty[J].J Arthroplasty,2014,29(8):1525-1527.
[18]Jahanshahi J,Hashemian F,Pazira S,et al.Effect of topical tranexamic acid on bleeding and quality of surgical field during functional endoscopic sinus surgery in patients with chronic rhinosinusitis:a triple blind randomized clinical trial[J].PLo S One,2014,9(8):e104477.
[19]Baric D,Biocina B,Unic D,et al.Topical use of antifibrinolytic agents reduces postoperative bleeding:a double-blind,prospective,randomized study[J].Eur J Cardiothorac Surg,2007,31(3):366-371.
[20]陈洁仪,欧阳惠娴,李春燕,等.急性高容量血液稀释联合控制性降压应用于脊柱手术的围术期护理干预[J].现代医院,2016,16(4):540-542.
[21]田山,陈海波,邹玲惠.控制性降压联合急性高容量血液稀释在脊柱外科手术中的应用[J].广州医学院学报,2012,40(3):50-52.
[22]吴萍,林梓霞,郑良杰,等.脊柱手术中血液稀释、控制性降压联合血液回收减少术中出血效果观察[J].山东医药,2014,54(30):89-90.
[2]Berenholtz SM,Pronovost PJ,Mullany D,et al.Predictors of transfusion for spinal surgery in Maryland:1997 to 2000[J].Transfusion,2002,42(2):183-189.
[3]Nuttall GA,Horlocker TT,Santrach PJ,et al.Predictors of blood transfusions in spinal instrumentation and fusion surgery[J].Spine,2000,25(5):596-601.
[4]Rohde JM,Dimcheff DE,Blumberg N,et al.Health care-associated infection after red blood cell transfusion:a systematic review and meta-analysis[J].JAMA,2014,311(13):1317-1326.
[5]Janssen SJ,Braun Y,Wood KB,et al.Allogeneic blood transfusions and postoperative infections after lumbar spine surgery[J].Spine J,2015,15(5):901-909.
[6]中华医学会.临床诊疗常规:骨科学分册[M].北京:人民卫生出版社,2009.
[7]董小雄,王永宏,张洪师,等.后路有限减压Dynesys动态固定治疗腰椎管狭窄症的早期临床疗效[J].中国骨科临床与基础研究杂志,2015,7(4):203-207.
[8]李丽彬,李桂焕,李智斐,等.退行性腰椎管狭窄症选择性椎板减压术后下床时间对其疗效的影响[J].广东医学,2010,31(23):3152-3154.
[9]林定坤,陈树东,苏国义,等.经肌间隙入路经椎间孔腰椎椎体间融合术并椎管潜行减压治疗腰椎管狭窄症[J].广东医学,2013,34(15):2336-2339.
[10]行勇刚,田伟,何达,等.经皮椎间孔镜治疗腰椎神经根孔狭窄的短期疗效观察[J].中国微创外科杂志,2016,16(5):445-448.
[11]禤天航,曹正霖,关宏刚,等.PELD与TLIF治疗腰椎间盘突出症并神经根管狭窄疗效比较[J].现代中西医结合杂志,2015,24(28):3085-3088.
[12]解京明,李韬,王迎松,等.大剂量氨甲环酸用于脊柱矫形手术的安全性和有效性[J].中国脊柱脊髓杂志,2016,26(1):48-54.
[13]杨元生,陈垦,石星亮,等.促红细胞生成素的临床应用进展[J].中华全科医学,2009,7(9):992-994.
[14]苏暄.快速康复关节外科的"独家"血液管理策略[J].中国医药科学,2015,5(8):1-3.
[15]解冰,田竞,杨超,等.重组人促红细胞生成素对降低老年股骨粗隆间骨折围手术期输血的病例对照研究[J].中国骨伤,2015,28(7):633-637.
[16]王健,杨伟胤,王可良.脊柱手术静脉应用氨甲环酸减少出血的荟萃分析[J].实用医学杂志,2015,31(2):279-282.
[17]Soni A,Saini R,Gulati A,et al.Comparison between intravenous and intra-articular regimens of tranexamic acid in reducing blood loss during total knee arthroplasty[J].J Arthroplasty,2014,29(8):1525-1527.
[18]Jahanshahi J,Hashemian F,Pazira S,et al.Effect of topical tranexamic acid on bleeding and quality of surgical field during functional endoscopic sinus surgery in patients with chronic rhinosinusitis:a triple blind randomized clinical trial[J].PLo S One,2014,9(8):e104477.
[19]Baric D,Biocina B,Unic D,et al.Topical use of antifibrinolytic agents reduces postoperative bleeding:a double-blind,prospective,randomized study[J].Eur J Cardiothorac Surg,2007,31(3):366-371.
[20]陈洁仪,欧阳惠娴,李春燕,等.急性高容量血液稀释联合控制性降压应用于脊柱手术的围术期护理干预[J].现代医院,2016,16(4):540-542.
[21]田山,陈海波,邹玲惠.控制性降压联合急性高容量血液稀释在脊柱外科手术中的应用[J].广州医学院学报,2012,40(3):50-52.
[22]吴萍,林梓霞,郑良杰,等.脊柱手术中血液稀释、控制性降压联合血液回收减少术中出血效果观察[J].山东医药,2014,54(30):89-90.