文章摘要

“改良鸡尾酒”在单节段腰椎后路融合术中的疗效

作者: 1王 超, 1夏 红, 1陈 刚, 1曾 凯斌, 1俞 海亮, 1张 稳
1 湘潭市中心医院脊柱外科,湖南 湘潭 411100
通讯: 夏 红 Email: 2468931540@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.02.016

摘要

目的:探讨“改良鸡尾酒”在单节段腰椎后路椎间融合术中应用的安全性和有效性。方法:选取2018年1月至2019年2月在湘潭市中心医院脊柱外科行单节段腰椎后路椎间融合术的60例患者作为研究对象,按随机数表法分为鸡尾酒组(A组,n=30)和生理盐水组(B组,n=30)。观察术后24 h引流量和总引流量,术前和术后第1,3天血红蛋白(Hb)值、血细胞比容(Hct)、二聚体值,术后深静脉血栓形成情况,术后4,8,12,24和48 h的VAS疼痛评分,干预前和干预后即刻,5 min,10 min和30 min心率、血压的变化,记录不良事件发生情况,术后随访1个月。结果:两组术后24 h引流量、总引流量和术后第1,3天Hb,Hct差异均有统计学意义(P<0.05);两组术中失血量差异无统计学意义(P>0.05);两组术后均无输血。A组术后4,8和12 h VAS疼痛评分低于B组,差异有统计学意义(P<0.05);术后24和48 h两组VAS疼痛评分差异无统计学意义(P>0.05)。两组不同时间收缩压、舒张压、心率差、术前和术后血浆D-二聚体值差异均无统计学意义(P>0.05)。两组病例中均未发生下肢深静脉血栓等不良事件;A组与B组各有1例出现切口延迟愈合,两组差异无统计学意义(P>0.05)。结论:局部应用“改良鸡尾酒”可以有效减少腰椎后路椎间融合术患者术后失血量,减轻其早期切口疼痛,不增加下肢深静脉血栓形成的风险。
关键词: 腰椎后路椎间融合术;改良鸡尾酒;氨甲环酸;肾上腺素;罗哌卡因

Effect of modified cocktail in single-level posterior lumbar fusion

Authors: 1WANG Chao, 1XIA Hong, 1CHEN Gang, 1ZENG Kaibin, 1YU Hailiang, 1ZHANG Wen
1 Department of Spinal Surgery, Central Hospital of Xiangtan, Xiangtan Hunan 411100, China

CorrespondingAuthor:XIA Hong Email: 2468931540@qq.com

Abstract

Objective: To investigate the safety and efficacy of “modified cocktail” in single-level posterior lumbar interbody fusion (PLIF). Methods: A total of 60 patients with single-segment PLIF from January 2018 to February 2019 in the spinal surgery department of Xiangtan Central Hospital were selected as subjects. They were randomly divided into a cocktail group (group A, n=30) and a saline group (group B, n=30). The 24-hour drainage volume and total drainage volume, hemoglobin value (HB), hematocrit (Hct), dimer value, postoperative deep venous thrombosis, VAS pain score at 4, 8, 12, 24 and 48 hours were observed before and after the intervention. The Changes of heart rate and blood pressure before intervention and were also observed immediately, 5, 10 and 30 minutes after intervention. The adverse events after operation were observed. The average follow-up time was 1 month. Results: There were significant differences in 24 h drainage volume, total drainage volume and HB and Hct on the 1st and 3rd day after operation between the two groups (P<0.05), but there was no significant difference in intraoperative blood loss between the two groups (P>0.05). There was no blood transfusion after operation in both groups. Compared with group B, VAS pain score in group A was lower at 4, 8 and 12 hours postoperatively (P<0.05), and VAS pain score at 24 and 48 hours postoperatively had no significant difference. There were no significant differences in systolic blood pressure, diastolic blood pressure, heart rate difference, preoperative and postoperative plasma D-dimer values between the two groups (P>0.05). There were no adverse events such as deep venous thrombosis of lower extremities in both groups, and delayed wound healing occurred in 1 case in group A and 1 case in group B, with no significant difference between the two groups. Conclusion: Local application of “modified cocktail” can effectively reduce the blood loss after lumbar posterior interbody fusion, reduce the pain of incision in the early stage, and do not increase the risk of deep vein thrombosis of lower limbs.
Keywords: posterior lumbar interbody fusion; improved cocktail; tranexamic acid; epinephrine; ropivacaine