ﺑﺮرﺳﻲ اﺛﺮات اﺳﺘﻔﺎده از ﺗﺮاﻧﻜﺴﺎﻣﻴﻚ اﺳﻴﺪ ورﻳﺪي در ﻛﺎﻫﺶ ﻣﻴﺰان ﺧﻮﻧﺮﻳﺰي اﻋﻤﺎل ﺟﺮاﺣﻲ ﻫﺮﻧﻴﺎﺳﻴﻮن دﻳﺴﻚ ﻛﻤﺮي ﺑﺎ دو روش ﺑﻴﻬﻮﺷﻲ اﺳﺘﻨﺸﺎﻗﻲ و ﺑﻴﻬﻮﺷﻲ ﻛﺎﻣﻞ داﺧﻞ ورﻳﺪي

Investigation of the Effects of Using Intravenous Tranexamic Acid on the Reduction of Blood Loss in Lumbar Hernial Disc Resection with Inhalation and Total Intravenous Anesthesia

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺗﺮﺍﻧﮑﺴﺎﻣﻴﮏ ﺍﺳﻴﺪ ﻳﮏ ﺩﺍﺭﻭﻱ ﺁﻧﺘﻲ ﻓﻴﺒﺮﻳﻨﻮﻟﻴﺘﻴﮏ ﺍﺳﺖ ﮐﻪ ﻣﻮﺟﺐ ﮐﺎﻫﺶ ﺧﻮﻧﺮﻳﺰﻱ ﻭ ﻧﻴﺎﺯ ﺑﻪ ﺗﺰﺭﻳﻖ ﺧﻮﻥ ﺩﺭ ﺍﻋﻤﺎﻝ ﺟﺮﺍﺣﻲ ﻗﻠﺐ ﻭ ﺁﺭﺗﺮﻭﭘﻼﺳﺘﻲ ﻣﻔﺼﻞ ﺯﺍﻧﻮ ﻣﻲ ﺷﻮﺩ. ﺩﺭ ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺍﺛﺮﺍﺕ ﺗﺮﺍﻧﮑﺴﺎﻣﻴﮏ ﺍﺳﻴﺪ ﭘﺮﻭﻓﻴﻼﮐﺘﻴﮏ ﺩﺭ ﮐﺎﻫﺶ ﺧﻮﻧﺮﻳﺰﻱ ﺣﻴﻦ ﻋﻤﻞ ﻭ ﺑﻬﺒﻮﺩ ﺩﻳﺪ ﺟﺮﺍﺡ ﺩﺭ ﺍﻋﻤﺎﻝ ﺟﺮﺍﺣﻲ ﺭﺯﮐﺴﻴـﻮﻥ ﺩﻳﺴﮏ ﺑﻴﻦ ﻣﻬـﺮﻩ ﺍﻱ ﮐﻤﺮﻱ ﺑﺎ ﺩﻭ ﺭﻭﺵ ﺑﻴﻬﻮﺷﻲ ﺍﺳﺘﻨﺸﺎﻗﻲ ﻭ ﺑﻴﻬـﻮﺷﻲ ﮐﺎﻣﻞ ﺩﺍﺧﻞ ﻭﺭﻳﺪﻱ ﺑﺮﺭﺳﻲ ﺧﻮﺍﻫﺪ ﺷﺪ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺗﻌﺪﺍﺩ ﺑﻴﻤﺎﺭ ﺩﺭ ﮐﻼﺱ II ASA ﻭ I ﺑﻪ ﻃﻮﺭ ﺗﺼﺎﺩﻓﻲ ﺑﻪ ﭼﻬـﺎﺭ ﮔﺮﻭﻩ ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ. ﺩﺭ ﮔـﺮﻭﻩ I ﺑﻴﻬﻮﺷﻲ ﮐﺎﻣﻞ ﺩﺍﺧﻞ ﻭﺭﻳﺪﻱ ﺑﻪ ﻫﻤـﺮﺍﻩ ﺗﺰﺭﻳﻖ ﺗـﺮﺍﻧﮑﺴﺎﻣﻴﮏ ﺍﺳﻴﺪ ﺑﻪ ﮐﺎﺭ ﺭﻓﺖ. ﺩﺭ ﮔـﺮﻭﻩ II ﻫﻤﺎﻧﻨﺪ ﮔـﺮﻭﻩ I ﻭﻟﻲ ﺗﺮﺍﻧﮑﺴﺎﻣﻴـﮏ ﺍﺳﻴﺪ ﺗـﺰﺭﻳﻖ ﻧﻤﻲ ﺷﺪ. ﺩﺭ ﮔـﺮﻭﻩ III ﺑﻴﻬﻮﺷﻲ ﺑﺎ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﻫﺎﻟـﻮﺗﺎﻥ ﻭ ﺗﺮﺍﻧﮑﺴﺎﻣﻴﮏ ﺍﺳﻴﺪ ﺗﺰﺭﻳﻖ ﻣﻲ ﺷـﺪ. ﺩﺭ ﮔـﺮﻭﻩ IV ﻫﻤﺎﻧﻨﺪ ﮔﺮﻭﻩ III ﻭﻟﻲ ﺗـﺮﺍﻧﮑﺴﺎﻣﻴﮏ ﺍﺳﻴﺪ ﺗﺰﺭﻳﻖ ﻧﻤﻲ ﺷـﺪ. ﻣﻴﺰﺍﻥ ﺧﻮﻧﺮﻳﺰﻱ ﻭ ﺭﺿﺎﻳﺖ ﺟﺮﺍﺡ ﺣﻴﻦ ﻋﻤﻞ ﺛﺒﺖ ﻣﻲ ﮔـﺮﺩﻳﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻣﻴﺰﺍﻥ ﺧﻮﻧﺮﻳﺰﻱ ﺩﺭ ﻫﺮ ﮔﺮﻭﻩ ﻋﺒﺎﺭﺕ ﺑﻮﺩ ﺍﺯ ﮔﺮﻭﻩ I= 177/3 ± 267/1 ﻣﻴﻠﻲ ﻟﻴﺘﺮ ، ﮔﺮﻭﻩ II = 411/6± 656 ﻣﻴﻠﻲ ﻟﻴﺘﺮ ، ﮔﺮﻭﻩ III= 307/2 ± 357 ﻣﻴﻠﻲ ﻟﻴﺘﺮ ، ﮔـﺮﻭﻩ IV = 406/7 ± 550 ﻣﻴﻠﻲ ﻟﻴﺘﺮ. ﮐﻤﺘﺮﻳﻦ ﻣﻴﺰﺍﻥ ﺧﻮﻧﺮﻳﺰﻱ ﺩﺭ ﮔﺮﻭﻩ I ﺛﺒﺖ ﺷﺪ ﮐﻪ ﺍﺧﺘﻼﻑ ﻗﺎﺑﻞ ﻣﻼﺣﻈﻪ ﺍﻱ ﺑﺎ ﮔﺮﻭﻩ P=0.007) II( ﻭ ﮔﺮﻭﻩ IV P=0.04)( ﺩﺍﺷﺖ ﮐﻪ ﺗﺮﺍﻧﮑﺴﺎﻣﻴﮏ ﺍﺳﻴﺪ ﺗﺠـﻮﻳﺰ ﻧﺸﺪﻩ ﺑﻮﺩ ﺧﻮﻧﺮﻳﺰﻱ ﺩﺭ ﮔﺮﻭﻩ II ﻭ IV ﻣﺸﺎﺑﻪ ﻫـﻢ ﺑﻮﺩ ﻭ ﺍﺧﺘﻼﻑ ﻗﺎﺑﻞ ﻣﻼﺣﻈﻪ ﺍﻱ ﻧﺪﺍﺷﺖ P=0.3(. ﺑﺎﻻﺗﺮﻳﻦ ﺭﺿﺎﻳﺖ ﺟﺮﺍﺡ ﺍﺯ ﮔـﺮﻭﻩ I ﺑﻮﺩ. ﻫﻴﭻ ﻋﺎﺭﺿﻪ ﺍﻱ ﺩﺭ ﭼﻬـﺎﺭ ﮔﺮﻭﻩ ﺩﻳﺪﻩ ﻧﺸﺪ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﻣﺎ ﻧﺘﻴﺠﻪ ﮔﺮﻓﺘﻴﻢ ﮐﻪ ﺗﺠﻮﻳﺰ ﭘـﺮﻭﻓﻴﻼﮐﺘﻴﮏ ﺗﺮﺍﻧﮑﺴﺎﻣﻴﮏ ﺍﺳﻴﺪ ﺩﺭ ﺍﻋﻤﺎﻝ ﺟـﺮﺍﺣﻲ ﺭﺯﮐﺴﻴﻮﻥ ﻫـﺮﻧﻴﺎﺳﻴﻮﻥ ﺩﻳﺴﮏ ﺑﻴﻦ ﻣﻬـﺮﻩ ﺍﻱ ﻣﻲ ﺗﻮﺍﻧﺪ ﺑﺎﻋـﺚ ﮐﺎﻫﺶ ﺧﻮﻧﺮﻳﺰﻱ ﺣﻴﻦ ﻋﻤﻞ ﻭ ﺑﻬﺒـﻮﺩ ﺩﻳﺪ ﺟﺮﺍﺡ ﺷﻮﺩ ﺑﻪ ﻭﻳـﮋﻩ ﺍﮔﺮ ﺑﺎ ﺭﻭﺵ ﺑﻴﻬـﻮﺷﻲ ﮐﺎﻣﻞ ﺩﺍﺧﻞ ﻭﺭﻳﺪﻱ ﻫﻤﺮﺍﻩ ﺑﺎﺷﺪ. ﺭﻭﺵ ﺑﻴﻬـﻮﺷﻲ ﺑﻪ ﺗﻨﻬﺎﻳﻲ ﻫﻴﭻ ﺗﺄﺛﻴـﺮﻱ ﺑﺮ ﻣﻴـﺰﺍﻥ ﺧﻮﻧﺮﻳﺰﻱ ﻧﺨﻮﺍﻫﻨـﺪ ﺩﺍﺷﺖ.

Introduction & Objective: Tranexamic acid is a synthetic antifibrinolytic drug that reduces bleeding and transfusion requirements in cardiac surgery and total knee arthroplasty. In this study, we evaluated the efficacy of the prophylactic tranexamic acid to reduce intraoperative bleeding and improving visual field of the surgeon in patients undergoing lumbar hernial disc resection, anesthetize with two different methods of inhalation or total intravenous anesthesia. Materials & Methods: Eighty percent patients in ASA class I-II were randomized into 4 groups. In group 1, anesthesia was achieved by total intravenous anesthesia and tranexamic acid was administered too. Other groups were: group 2, anesthesia by total intravenous anesthesia without tranexamic acid, group 3, anesthesia by halothane and tranexamic acid was administered and in group 4, anesthesia by halothane without tranexamic acid was achieved. Blood loss and surgeon's satisfaction were registered. Results: The amount of blood loss in each group was as follow: Group 1: 267.1 ± 177.3 ml; group 2: 656 ± 411.6 ml Group 3: 357 ± 307.2 ml; group 4: 550 ± 406.7 ml The least bleeding was recorded in group 1 which had a significant difference with group 2 (p=0.007) and group 4 (p=0.04) that tranexamic acid was not administered. Blood loss in group 2 and 4 was identical and had no significant difference (p= 0.3). Surgeon's highest satisfaction was with group 1. No complications were registered in 4 groups. Conclusions: We concluded that administration of prophylactic tranexamic acid in patients undergoing hernial disc resection has the potential to reduce intraoperative bleeding and improving visualization of the surgical field especially when administered with total intravenous anesthesia. The method of anesthetic management had no effect.