氨甲环酸在脊柱手术围手术期的应用研究进展

Research Progress on the Application of Tranexamic Acid in the Perioperative Period of Spinal Surgery

摘要: 近年来，随着社会持续发展和社会老龄化日益严重，脊柱退行性病变的病患数量激增，导致脊柱外科手术在临床上备受关注。术中术后阶段作为脊柱外科手术的关键环节，合理调控与管理手术期间的出血量至关重要，对患者的术后恢复及长期预后产生直接且显著的影响。在此领域中，氨甲环酸(tranexamic acid, TXA)作为一线抗纤溶药物，已被证明可有效减少围手术期出血和创伤性出血。TXA静脉输注现已广泛应用于脊柱手术围手术期，然而，高剂量TXA的给药与癫痫发作和其他增加护理成本的不良反应有关，因此需要标准化TXA以减少围手术期出血。本文针对静脉应用TXA在脊柱手术围手术期适当给药时机、剂量及其有效性和安全性进行综述。

Abstract: In recent years, with the continuous development of society and the increasing severity of population aging, the number of patients with degenerative spinal diseases has surged, leading to heightened clinical attention on spinal surgeries. The intraoperative and postoperative phases, as critical components of spinal surgery, require meticulous management and control of blood loss, which directly and significantly impacts patients’ postoperative recovery and long-term prognosis. In this context, tranexamic acid (TXA), as a first-line antifibrinolytic agent, has been proven effective in reducing perioperative and traumatic bleeding. Intravenous administration of TXA is now widely used in the perioperative period of spinal surgeries. However, high-dose TXA administration has been associated with adverse effects such as seizures and other complications that increase healthcare costs. Therefore, there is a need to standardize TXA usage to minimize perioperative bleeding. This article reviews the appropriate timing, dosage, efficacy, and safety of intravenous TXA administration during the perioperative period of spinal surgeries.