关键词: 加速康复外科, 氨甲环酸, 脊柱融合手术, 凝血, 浸泡, 出血

Abstract: Objective To evaluate the safety and effectiveness of intraoperative local application of aminocycline when performing ERAS(enhanced recovery after surgery) measures during the perioperative period of lumbar posterior fusion.
Method A total of 102 patients who underwent 2-level spinal fusion surgery in our hospital from January 2019 to January 2020 were selected and randomly divided into 2 groups,namely the intraoperative local application of tranexamic acid(experimental group) and intraoperative local The normal saline group(control group).There were 51 cases in each group.In the experimental group,1.5g of tranexamic acid(Lidafei) for injection was dissolved in 100ml of normal saline before the operation was sutured,the wound was soaked for 5 minutes,and the liquid was sucked out before suture.In the control group,the wound was soaked in 100ml of physiological saline for 5 minutes before suturing,and then sutured after sucking out the saline.Record the four coagulation items and D-dimer values of the two groups of patients before operation and the wound drainage,coagulation four items and D-dimer values of the patients on the first day,the second day,and the third day after the operation.
Results No thrombotic disease occurred in the two groups of patients after surgery.The drainage volume of the experimental group was(60±20)ml on the first postoperative day,(20±10)ml on the second postoperative day,and the wound drainage volume on the third day after surgery was(15±5)ml;in the control group,the drainage on the first day after surgery was(160±80)ml,the drainage on the second day after surgery was(100±30)ml,and the drainage on the third day after surgery was(45±5)ml.The difference between the two groups was Obviously,it is statistically significant(P＜0.05).There was no significant difference between the two groups in the four coagulation values of patients on the first day,the second day and the third day after the operation,and it was not statistically significant(P>0.05).The value of D-dimer in the experimental group before operation(0.82±0.16)mg/L,the first day after operation(1.82±0.21)mg/L,the second day(1.85±0.41)mg/L,the third day after operation D-dimer(1.22±0.43)mg/L;preoperative D-dimer value of the control group was (0.88±0.12)mg/L,postoperative day 1(2.67±1.32)mg/L,postoperative day 2(3.11±2.60)mg/L,postoperative day 3(2.21±1.06)mg/L. The comparison between the two experimental groups was significantly lower than the control group,the difference was statistically significant(P＜0.05).
Conclusion The topical application of tranexamic acid immersion to the wound during spinal fusion surgery can effectively reduce postoperative wound bleeding without increasing related complications.It is safe and effective.It reflects the scientific concept of ERAS and can be used as an important part of the ERAS concept in spinal surgery.Worth promoting.

Key words: enhanced recovery after surgery, tranexamic acid, spinal fusion surgery; , coagulation, immersion, bleeding