Analysis of the Clinical Efficacy of Intravenous Application of Hemostatic Drugs in Improving the Clarity of Vision Under Endoscope, Perioperative Bleeding Volume and Anti-inflammatory Effect of Spinal Endoscopic Lumbar Fusion

To study the clinical efficacy of carosodiumsulfonate and desmopressin in improving the clarity of vision under endoscope, perioperative bleeding volume and anti-inflammatory effect in endoscopic lumbar fusion

A total of 129 patients diagnosed with lumbar spondylolisthesis and undergoing endoscopic lumbar fusion in our hospital from February 2024 to February 2025 were prospectively enrolled in this trial. All subjects who met the inclusion criteria were enrolled in the trial after signing the informed consent form. After completing the relevant information registration, routine preoperative preparation was performed and relevant baseline data were collected. The randomization scheme was completed by specialized statisticians independently and was not affected by the subjective will of the researchers and the subjects. According to the random number table method, all subjects were equally allocated to group A, group B and group C at a ratio of 1:1:1. Participants and investigators were blinded to group assignments until the end of the study and were blinded only if a participant developed a serious complication during treatment. Blood routine, liver function, renal function, electrolytes, coagulation indexes and other hematological tests were routinely performed before operation. The volume of blood drawn was about 15ml. Experimental group (group A) : Intravenous infusion of caroxime sodium sulfonate and sodium chloride injection 100ml (caroxime sodium sulfonate 80mg and sodium chloride 0.9g) (Chongqing Dikang) was given 5 minutes before operation. One hour after operation, intravenous infusion of carosene sodium sulfonate injection 100ml (carosene sodium sulfonate 80mg and sodium chloride 0.9g) (Chongqing Dicang) \[reference to Weiluojing (Carosene sodium sulfonate sodium chloride injection) 100ml (80mg: 0.9g) Usage and dosage: intravenous infusion of 80mg each time (approval number: Chinese Medicine approval number H20052472)\]; Experimental group (group B) : Intravenous infusion of desmopressin injection 15ug (Shenzhen Hanyu) +0.9% sodium chloride injection 100ml 5 minutes before surgery, intravenous infusion of desmopressin injection 15ug (Shenzhen Hanyu) +0.9% sodium chloride injection 100ml 1 hour after surgery \[according to the instructions of desmopressin injection (Hangu), usage and dosage: 1. Control of bleeding or prevention of bleeding before operation: according to the dose of 0.3ug/kg body weight, diluted to 50-100ml with normal saline, intravenous infusion within 15-30min (approval number: H20064093); In control group (group C), 100ml 0.9% sodium chloride solution was intravenously infused 5 minutes before surgery and again 1 hour after surgery. Intraoperative Gertzbein-Sload (GS) score was used to score the clarity of the intraoperative visual field under the microscope. During the operation, the operation time and the total amount of perfusate were recorded, and the red blood cell count was measured by taking the perfusate from the drainage bottle. The blood routine, erythrocyte sedimentation rate, CRP and IL-6 were rechecked at 3 days, and the amount of blood drawn was about 10ml each time. The total blood loss, intraoperative blood loss and hidden blood loss of the patients were recorded, and the VAS scores at 1 day, 2 days and 3 days after operation were recorded. To evaluate the effect of intravenous administration of carosodiumsulfonate and desmopressin on the clarity of visual field under endoscope, perioperative blood loss and postoperative inflammatory indicators in endoscopic lumbar fusion.

Eligibility Criteria:
Inclusion Criteria:

1. Patients, aged 35-65 years old, who were diagnosed as single-segment lumbar spondylolisthesis without spondylolysis based on imaging data and underwent endoscopic lumbar interbody fusion.
2. In patients with normal platelet count, blood coagulation function.
3. No history of major lumbar trauma and previous lumbar surgery.
4. No allergy history, contraindications and serious adverse reactions to desmopressin and carosodiumsulfonate.
5. American Society of Anesthesiologists (ASA) classification: grade 1-2
6. The participants and their family members were informed of the nature of the study, understood the provisions of the study, complied well, and signed informed consent

Exclusion Criteria:

1. Patients who do not consent to participate in the trial.
2. Poorly controlled hypertension with systolic blood pressure \>180 mmHg or diastolic blood pressure \>110 mmHg.
3. People with mental illness, or poor compliance of patients.
4. Patients with severe liver function impairment and creatinine clearance \<20ml/min.
5. Patients with coagulopathy or inability to tolerate surgery.
6. Patients with other lumbar spine diseases or pulmonary tuberculosis.
7. ASA anesthesia level 3 or higher.
8. Patients with a long history of smoking, alcohol abuse, or contraceptive drug abuse.
9. Patients with serious heart disease, diabetes.
10. Imaging tip is merged with other lumbar disease or accompanied by lumbar spondylolysis patients.
11. Pregnant women.
12. Patients with a history of major lumbar trauma or lumbar surgery.