發(fā)布時(shí)間：2018-04-28 04:07

  本文選題：早發(fā)性脊柱側(cè)凸 + 半椎體切除��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]評(píng)價(jià)大劑量氨甲環(huán)酸(tranexamic acid, TXA)應(yīng)用于兒童早發(fā)性脊柱側(cè)凸患者的半椎體切除并后路融合手術(shù)中的安全性和有效性。[方法]從2013年2月到2017年3月之間在昆明醫(yī)科大學(xué)第二附屬醫(yī)院骨科就診的小于10歲的擬行單個(gè)半椎體切除并后路融合手術(shù)的早發(fā)性脊柱側(cè)凸(early onset scoliosis,EOS)患者中篩選出69例納入本研究。將入選本研究的患者隨機(jī)分為應(yīng)用大劑量TXA的TXA組和應(yīng)用等量生理鹽水的對(duì)照組。TXA組包含35個(gè)病例,使用100mg/kg負(fù)載量和10mg/kg/h維持量的TXA,對(duì)照組包含34個(gè)病例,使用和TXA組相同劑量方案的生理鹽水。所有患者的手術(shù)都在同一主刀醫(yī)生和同一麻醉醫(yī)師的協(xié)作下完成,所有患者均行單個(gè)半椎體切除,其中小于3歲的患者行2個(gè)節(jié)段的脊柱融合,而大于3歲的患者根據(jù)畸形的程度分別進(jìn)行2～7個(gè)節(jié)段的融合。統(tǒng)計(jì)術(shù)中出血量、真實(shí)出血量(出血量/血容量× 100% )和術(shù)中輸血量來(lái)評(píng)價(jià)TXA的有效性;統(tǒng)計(jì)相關(guān)并發(fā)癥,包括肝腎功能損害、深靜脈血栓形成(deep venous thrombosis,DVT)、急性心肌梗死(acute myocardial Infarction, AMI)、肺栓塞、心律失常和癲癇來(lái)評(píng)價(jià)TXA的安全性。[結(jié)果]①兩組患者在性別、年齡、體重、血容量、融合節(jié)段數(shù)及手術(shù)時(shí)間方面無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);分別比較兩組中≤3歲、3～6歲和≥6歲患者的上訴指標(biāo),也均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。②TXA組的術(shù)中出血量[(385±181) ml]、真實(shí)出血量[(26.1±9.6)%]都顯著小于對(duì)照組[分別為(588±171) ml, (40.5±7.6) %,均 P0.05]。③ TXA組較對(duì)照組有著更少的術(shù)中輸血量[(349±141) ml比(495±177) ml,P 0.05]。④TXA組中≤歲、3～6歲和≥6歲的患兒的術(shù)中出血量、真實(shí)出血量和術(shù)中輸血量都顯著少于對(duì)照組中相應(yīng)≤歲、3～6歲和≥6歲的患兒(P0.05)。⑤TXA組和對(duì)照組相比,術(shù)前及術(shù)后一天的血紅蛋白、紅細(xì)胞壓積、凝血酶原時(shí)間(PT)、活化部分凝血活酶時(shí)間(APTT)、纖維蛋白原(FIB)、國(guó)際標(biāo)準(zhǔn)化比值(INR)、天冬氨酸轉(zhuǎn)氨酶(AST)、丙氨酸轉(zhuǎn)氨酶(ALT)和血肌酐(SCr)的檢驗(yàn)值以及術(shù)中尿量均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05) ; TXA組和對(duì)照組中≤歲、3～6歲和≥6歲患兒的上訴指標(biāo)也均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05) 。⑥兩組的所有患者中都沒(méi)有出現(xiàn)DVT、AMI、肺栓塞和癲癇等相關(guān)并發(fā)癥。[結(jié)論]大劑量氨甲環(huán)酸能夠有效減少兒童早發(fā)性脊柱側(cè)凸患者半椎體切除手術(shù)中的出血量和輸血量,并且是安全的。
[Abstract]:[objective] to evaluate the safety and efficacy of high dose tranexamic acid (TXA) in hemivertebra resection and posterior fusion in children with early scoliosis. [methods] from February 2013 to March 2017, patients under 10 years old who were admitted to the Department of Orthopaedics, second affiliated Hospital of Kunming Medical University, undergoing single hemivertebra resection and posterior fusion surgery, were diagnosed with early onset scoliosissis (EOS) patients with middle sieve. 69 cases were selected to be included in this study. The patients in this study were randomly divided into two groups: the TXA group with high dose of TXA and the control group with the same amount of normal saline. The patients in the TXA group were treated with 100mg/kg load and 10mg/kg/h maintenance, while the control group consisted of 34 cases. Use the same dosage of saline as the TXA group. All patients underwent surgery in collaboration with the same surgeon and anesthesiologist. All patients underwent a single hemivertebra resection, with two segments of spinal fusion performed in patients younger than 3 years of age. Patients over 3 years of age were fused with 2 to 7 segments according to the degree of malformation. To evaluate the effectiveness of TXA by counting intraoperative bleeding volume, real bleeding volume (bleeding volume / blood volume 脳 100%) and blood transfusion volume during operation, the related complications, including liver and kidney dysfunction, were analyzed. Deep venous thromboplasms were used to evaluate the safety of venous, acute myocardial intervention, AMI, pulmonary embolism, arrhythmia and epilepsy. [results] 1There was no significant difference in sex, age, body weight, blood volume, number of fusion segments and operation time between the two groups (P 0.05). There was also no significant difference in intraoperative blood loss [385 鹵181ml] and real blood loss (26.1 鹵9.6%) in the P0.05TXA group, which were significantly lower than those in the control group (588 鹵171ml, 40.5 鹵7.6ml, P0.05). The blood transfusion volume in the TXA group was significantly lower than that in the control group (349 鹵141ml vs 495 鹵177ml, P 0.05). The amount of intraoperative blood loss in children with 鈮，

本文編號(hào)：1813694