左旋布比卡因联合氨甲环酸在脊柱后路手术中的应用效果
|
摘要
目的探讨左旋布比卡因联合氨甲环酸应用于脊柱后路手术的安全性与有效性。方法随机选取行胸腰椎后路手术的80例患者,使用随机数表法将其随机分为观察组(缝皮后局部浸润注射左旋布比卡因+氨甲环酸混合溶液20 mL)和对照组(缝皮后局部浸润注射生理盐水20 mL),分别检测患者术后3 d血红蛋白下降值、术后引流量、输血率、视觉模拟疼痛评分(visual analogue scale)、补救镇痛率、术后并发症发生率等指标。之后应用SPSS 19.0统计软件行统计学分析。结果观察组在术后6、12、24、48 h的VAS疼痛评分均低于对照组,差异有统计学意义(P<0.05)。观察组在术后0～11 h、12～23 h补救镇痛率要低于对照组,差异有统计学意义(P<0.05)。观察组的术后引流量要明显低于对照组,差异有统计学意义(P<0.05)。观察组在术后1、3 d血红蛋白量要明显高于对照组,差异有统计学意义(P<0.05)。两组的切口愈合时间和术后并发症发生率比较,差异均无统计学意义(P>0.05)。结论脊柱后路手术中局部应用左旋布比卡因联合氨甲环酸预防术后出血与术后疼痛兼具安全性和有效性,值得深入研究推广。
Objective To assess the safety and efficacy of levobupivacaine with tranexamic acid in posterior spinal approach surgery. Methods Eighty patients who underwent thoracolumbar posterior surgery were prospectively randomly selected and divided into experimental group(local injection of 20 mL mixed solution of levobupivacaine and tranexamic acid after suture) and control group(local injection of 20 ml saline after suture) by random number table. The decrease in hemoglobin, amount of post-operation drainage, transfusion rate, visual analogue scale, remedial analgesia rate and postoperative complications rate were recorded and compared on the 3 rd day after surgery. The results were analyzed statistically using SPSS Statistics 19.0 software. Results The VAS pain scores 6, 12, 24 and 48 hours after operation of in the experimental group were significantly lower than those in the control group(P<0.05). The remedial analgesia rates 0-12 h and 12-24 h after operation in the experimental group was significantly lower than those in the control group(P<0.05). The amount of post-operation drainage in experimental group was significantly less than that in the control group(P<0.05). The amounts of hemoglobin on the 1 st and 3 rd day after operation in the experimental group were significantly higher than those in the control group(P<0.05). No statistically significant differences in wound healing time and complications rate after the operation were found between the experimental group and the control group(P>0.05). Conclusion The local application of levobupivacaine and tranexamic acid in spinal posterior surgery have a safety and higher effect in preventing postoperative bleeding.
Objective To assess the safety and efficacy of levobupivacaine with tranexamic acid in posterior spinal approach surgery. Methods Eighty patients who underwent thoracolumbar posterior surgery were prospectively randomly selected and divided into experimental group(local injection of 20 mL mixed solution of levobupivacaine and tranexamic acid after suture) and control group(local injection of 20 ml saline after suture) by random number table. The decrease in hemoglobin, amount of post-operation drainage, transfusion rate, visual analogue scale, remedial analgesia rate and postoperative complications rate were recorded and compared on the 3 rd day after surgery. The results were analyzed statistically using SPSS Statistics 19.0 software. Results The VAS pain scores 6, 12, 24 and 48 hours after operation of in the experimental group were significantly lower than those in the control group(P<0.05). The remedial analgesia rates 0-12 h and 12-24 h after operation in the experimental group was significantly lower than those in the control group(P<0.05). The amount of post-operation drainage in experimental group was significantly less than that in the control group(P<0.05). The amounts of hemoglobin on the 1 st and 3 rd day after operation in the experimental group were significantly higher than those in the control group(P<0.05). No statistically significant differences in wound healing time and complications rate after the operation were found between the experimental group and the control group(P>0.05). Conclusion The local application of levobupivacaine and tranexamic acid in spinal posterior surgery have a safety and higher effect in preventing postoperative bleeding.
引文
[1] McCormack PL.Tranexamic acid:a review of its use in the treatment of hyperfibrinolysis[J].Drugs,2012,72(5):585-617.
[2] Xie J,Hu Q,Huang Q,et al.Comparison of intravenous versus topical tranexamic acid in primary total hip and knee arthroplasty:An updated meta-analysis[J].Thromb Res,2017,153:28-36.
[3] Carvalho LH Jr,Frois Temponi E,Machado Soares LF,et al.Bleeding reduction after topical application of tranexamic acid together with Betadine solution in total knee arthroplasty:a randomised controlled study[J].Orthop Trau-matol Surg Res,2015,101(1):83-87.
[4] Mirghafourvand M,Mohammad Alizadeh S,Abbasalizadeh F,et al.The effect of prophylactic intravenous tranexamic acid on blood loss after vaginal delivery in women at low risk of postpartum haemorrhage:a doubleblind randomised cont-rolled trial[J].Aust N Z J Obstet Gynaecol,2015,55(1):53-58.
[5] 于兆祥,段显亮.局部应用氨甲环酸在脊柱外科手术中的安全性和有效性研究[J].北华大学学报:自然科学版,2018,19(1):91-94.
[6] Xie J,Lenke LG,Li T,et al.Preliminary investigation of highdose tranexamic acid for controlling intraoperative blood loss in patients undergoing spine correction surgery[J].Spine J,2015,15(4):647-654.
[7] Demiraran Y,Albayrak M,Yorulmaz IS,et al.Tramadol and levobupivacaine wound infiltration at cesarean delivery for postoperativeanalgesia[J].J Anesth,2013,27(2):175-179.
[8] Niemelainen M,Kalliovalkama J,Aho AJ,et al.Single periarticular local infiltration analgesia reduces opiate consumption until 48 hours after total knee arthroplasty.A randomized placebo-controlled trial involving 56 patients[J].Acta Orthop,2014,85(6):614-619.
[9] 严广斌.视觉模拟评分法[J].中华关节外科杂志:电子版,2014,8(2):34.
[10] 严广斌,余楠生,卢永辉,等.罗哌卡因复合液关节周围注射对膝关节置换术后镇痛的效果评价[J].中国骨与关节外科,2013,6(3):258-261.
[11] Shinnick JK,Short HL,Heiss KF,et al.Enhancing recovery in pediatric surgery:a review of the literature[J].J Surg Res,2016,202(1):165-176.
[12] Perinel J,Adham M.ERAS and pancreatic surgery:a review[J].Updates Surg,2016,68(3):253-255.
[13] 孙扬,杨明敏,李亦梅.人工全膝关节置换围术期镇痛方法:多模式方案及最佳疼痛管理[J].中国组织工程研究,2014,18(44):7188-7193.
[14] Fleege C,Arabmotlagh M,Almajali A,et al.Pre-and postoperative fast-track treatment concepts in spinal surgery:patient infor-mation and cooperation[J].Orthopade,2014,43(12):1062-1064,1066-1069.
[15] 李红岩,石敏,范新成,等.全麻联合局部浸润麻醉对患者全膝关节置换术后镇痛的影响[J].中华临床医师杂志,2015,9(22):4237-4239.
[16] Liu H,Yang C,Zheng Z,et al.Comparison of Smith-Petersen osteotomy and pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis:a systematic review and meta-analysis[J].Spine (Phila Pa 1976),2015,40(8):570-579.
[17] Jacob M,Kumar P.The challenge in management of hemor-rhagic shock in trauma[J].Med J Armed Forces India,2014,70(2):163-169.
[2] Xie J,Hu Q,Huang Q,et al.Comparison of intravenous versus topical tranexamic acid in primary total hip and knee arthroplasty:An updated meta-analysis[J].Thromb Res,2017,153:28-36.
[3] Carvalho LH Jr,Frois Temponi E,Machado Soares LF,et al.Bleeding reduction after topical application of tranexamic acid together with Betadine solution in total knee arthroplasty:a randomised controlled study[J].Orthop Trau-matol Surg Res,2015,101(1):83-87.
[4] Mirghafourvand M,Mohammad Alizadeh S,Abbasalizadeh F,et al.The effect of prophylactic intravenous tranexamic acid on blood loss after vaginal delivery in women at low risk of postpartum haemorrhage:a doubleblind randomised cont-rolled trial[J].Aust N Z J Obstet Gynaecol,2015,55(1):53-58.
[5] 于兆祥,段显亮.局部应用氨甲环酸在脊柱外科手术中的安全性和有效性研究[J].北华大学学报:自然科学版,2018,19(1):91-94.
[6] Xie J,Lenke LG,Li T,et al.Preliminary investigation of highdose tranexamic acid for controlling intraoperative blood loss in patients undergoing spine correction surgery[J].Spine J,2015,15(4):647-654.
[7] Demiraran Y,Albayrak M,Yorulmaz IS,et al.Tramadol and levobupivacaine wound infiltration at cesarean delivery for postoperativeanalgesia[J].J Anesth,2013,27(2):175-179.
[8] Niemelainen M,Kalliovalkama J,Aho AJ,et al.Single periarticular local infiltration analgesia reduces opiate consumption until 48 hours after total knee arthroplasty.A randomized placebo-controlled trial involving 56 patients[J].Acta Orthop,2014,85(6):614-619.
[9] 严广斌.视觉模拟评分法[J].中华关节外科杂志:电子版,2014,8(2):34.
[10] 严广斌,余楠生,卢永辉,等.罗哌卡因复合液关节周围注射对膝关节置换术后镇痛的效果评价[J].中国骨与关节外科,2013,6(3):258-261.
[11] Shinnick JK,Short HL,Heiss KF,et al.Enhancing recovery in pediatric surgery:a review of the literature[J].J Surg Res,2016,202(1):165-176.
[12] Perinel J,Adham M.ERAS and pancreatic surgery:a review[J].Updates Surg,2016,68(3):253-255.
[13] 孙扬,杨明敏,李亦梅.人工全膝关节置换围术期镇痛方法:多模式方案及最佳疼痛管理[J].中国组织工程研究,2014,18(44):7188-7193.
[14] Fleege C,Arabmotlagh M,Almajali A,et al.Pre-and postoperative fast-track treatment concepts in spinal surgery:patient infor-mation and cooperation[J].Orthopade,2014,43(12):1062-1064,1066-1069.
[15] 李红岩,石敏,范新成,等.全麻联合局部浸润麻醉对患者全膝关节置换术后镇痛的影响[J].中华临床医师杂志,2015,9(22):4237-4239.
[16] Liu H,Yang C,Zheng Z,et al.Comparison of Smith-Petersen osteotomy and pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis:a systematic review and meta-analysis[J].Spine (Phila Pa 1976),2015,40(8):570-579.
[17] Jacob M,Kumar P.The challenge in management of hemor-rhagic shock in trauma[J].Med J Armed Forces India,2014,70(2):163-169.