醋酸去氨加压素在椎间孔镜手术中的应用

Application of Desmopressin Acetate injection in percutaneous endoscopic lumbar discectomy

摘要:

摘要：目的??观察在椎间孔镜手术前应用醋酸去氨加压素对术中出血量、血液相关指标的影响，评价其在临床上的应用价值。方法?选取2017年11月－2018年7月在该院行椎间孔镜手术的腰椎间盘突出症患者135例为研究对象，随机数字法分为对照组和试验组。对照组67例，试验组68例，对照组患者常规术前准备，试验组患者在常规术前准备基础上，术前30 min静脉应用醋酸去氨加压素3 ml。比较两组患者镜下效果、术中出血情况、手术时间及血液相关指标[血红蛋白浓度（HGB）、红细胞压积（HCT）、血小板数目（PLT）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）]。结果?试验组镜下效果满意37例，一般31例，差0例，对照组镜下效果满意23例，一般39例，差5例。试验组术中出血量（9.93±1.10）ml， 手术时间（62.78±7.63）min，对照组术中出血量（10.68±1.34）ml，手术时间（67.43±8.28）min，术前两组患者各项血液指标比较，差异无统计学意义（P >0.05）；术后两组患者的HCT和PT差异无统计学意义（P >0.05），试验组患者HGB和PLT与对照组比较，差异有统计学意义（P <0.05），试验组患者APTT与对照组比较，差异有统计学意义（P <0.01）；对照组患者各项血液相关指标术前与术后比较，差异无统计学意义（P >0.05），试验组患者HGB、HCT、PLT和PT术前与术后比较，差异无统计学意义（P >0.05），试验组患者APTT术前与术后比较，差异有统计学意义（P <0.01）。结论?醋酸去氨加压素应用于腰椎椎间孔镜手术中，可启动内源性凝血途径，缩短部分活化凝血活酶时间，促进凝血，达到止血的目的，对控制患者术中出血量有积极的意义，从而提高镜下效果，缩短手术时间，值得在临床上大力推广。

Abstract:

Abstract: Objective?To observe the effect of Desmopressin Acetate injection before percutaneous endoscopic lumbar discectomy and evaluate its clinical value.?Methods?135 patients with lumbar disc herniation who underwent percutaneous endoscopic lumbar discectomy from November 2017 to July 2018 were divided into control group and test group by random number method. Patients in the control group (67 cases) received routine preoperative preparation, and patients in the test group (68 cases) received 3 ml Desmopressin Acetate injection intravenously half an hour before surgery on the basis of routine preoperative preparation. Effect under the endoscope, mean bleeding volume, operation time and blood related indicators (HGB, HCT, PLT, PT, APTT and FIB) were compared between the two groups.?Results?In the test group, the effect under the endoscope was satisfactory in 37 cases, general in 31 cases and poor in 0 cases, while in the control group, it was satisfactory in 23 cases, general in 39 cases and poor in 5 cases. In the test group, mean bleeding volume was (9.93 ± 1.10) ml, and operative time was (62.78 ± 7.63) min, while in the control group mean bleeding volume was (10.68 ± 1.34) ml and the operative time was (67.43 ± 8.28) min. There was no statistically significant difference in blood parameters between the two groups before surgery (P > 0.05). There was no significant difference in HCT and PT between the two groups after surgery (P > 0.05). There were statistic differences in HGB, and PLT between the two groups after surgery (P < 0.05). There were significant differences in APTT between the two groups after surgery (P < 0.01). In the control group, there were no statistically significant differences in blood related indicators before and after operation (P > 0.05), while in the test group there were no statistically significant differences in HGB, HCT, PLT and PT before and after the operation (P > 0.05), and significant differences in APTT before and after the operation (P < 0.01).?Conclusion?Desmopressin Acetate injection used in percutaneous endoscopic lumbar discectomy, can start the intrinsic coagulation pathways, shorten the APTT, promote blood clotting, achieve the purpose of hemostasis. It was positive to control the intraoperative blood loss, improve the effect under the endoscope and shorten the operation time. So it is worth promoting in clinic.