摘要
目的探讨小剂量氨甲环酸静脉重复给药对全膝关节置换术失血量的影响,并进行安全性评估。方法对2012年1月~2013年12月西安交通大学医学院附属红会医院收治的390例初次行单侧全膝关节置换术的患者资料进行回顾性分析。390例患者被随机分为3组,对照组130例;单次剂量组130例:术中松止血带前20 min给予1000 mg氨甲环酸静脉滴注;双次剂量组130例:分别于术中松止血带前20 min、术后3 h各1000 mg氨甲环酸静脉滴注。记录术后48 h引流量、隐性失血量、术后12 h血红蛋白减少量、输血量,术后14 d观察患者是否出现下肢深静脉栓塞症状,术后1个月随访是否有深静脉血栓形成表现,必要时超声检查。结果单次剂量组术后引流量、隐性失血量分别为(550±156)m L、(352±237)m L;双次剂量组术后引流量、隐性失血量分别为(426±198)m L(221±216)m L、,明显低于对照组(P<0.05),其中双次剂量组最低。术后12 h血红蛋白保持水平单次剂量组[减少量为(2.2±0.7)g/d L]及双次剂量组[减少量为(1.6±0.5)g/d L]明显高于对照组(P<0.05),术后输血量双次剂量组(0.4±0.2)U明显低于单次剂量组(0.7±0.6)U和对照组(1.6±0.8)U.差异有统计学意义(P<0.05),所有患者术后未发现下肢深静脉血栓形成。结论小剂量氨甲环酸能显著减少全膝关节置换术后失血量,氨甲环酸并没有增加术后下肢深静脉血栓及肺栓塞的风险,另外,术后重复给药可以显著减少全膝关节置换术患者的输血量。
Objective To evaluate the effect .of repeat-dose tranexamic acid（ TXA）on blood loss during total knee arthroplasty （TKA） and to evaluate its safety. Methods From January ：2012 to December 2013, clinical 390 patients undergoing cemented TKAs were analyzed retrospectively. Consecutive patients were divided into three groups, as follows： control group （n=130）, single-TXA group （n=130） in whom TXA （1000 mg） was intravenously administered 10 min before deflation of the tourniquet, and twice-TXA group （n=130） in whom TXA （1000 mg） was intravenously administered 10 min before deflation of the tourniquet and 3 h a^ter the operation. We measured the volume of drained blood at 48 hours postoperatively aug hidden blood loss. Haemoglobin （Hb） levels were measured at 12 hours postoperative, the number of patients requiring blood transfusion were recorded and compared. Deep-vein thrombosis （DVT） were examined using the color Doppler ultrasonography at enrollment 14 day after operation. Results The mean postoperative volumes of drained blood and hidden blood loss in the single-TXA group and twice-TXA group were significantly lower than those in the control group （P〈0.05）, which twice-TXA group had the lowest values. Furthermore, the single-TXA group and twice-TXA group could maintain the Hb level better than control group （P〈0.05） .The amount of blood transfusion in twice-TXA group were significantly lower than those in the control group and the single-TXA group and （P〈0.05）. No DVT was found 14 day after operation. Conclusion Administration of TXA twice ear, reduce postoperative blood loss after TKA, and TXA is not associated with the risk of DVT or pulmonary embolism （PE）. Further, administration of TXA twice may eliminate the need for blood transfusion during TKA.
出处
《当代医学》
2014年第32期5-7,共3页
Contemporary Medicine
关键词
全膝关节置换术
失血
引流
氨甲环酸
Total knee arthroplasty
Bleeding
Drain
Tranexamic acid
