摘要
目的 探讨关节腔内使用氨甲环酸对全膝关节置换术（TKA）后失血量的影响及安全性. 方法 回顾性分析2013年6月至2014年5月期间行TKA治疗的60例患者资料,根据手术过程中关节腔内是否使用氨甲环酸分为两组：氨甲环酸组30例,在缝合关节囊后关节腔内注射1g氨甲环酸,加生理盐水稀释至20 mL;对照组30例,给予等量生理盐水注射.术后闭合引流3h,观察并比较两组患者术后6、24、72 h血红蛋白下降率、凝血3项、术后24 h引流量、隐性失血量、总失血量,同时评估两组患者术后是否出现下肢深静脉血栓形成（DVT）和肺栓塞（PE）. 结果 60例患者术后获6～17个月（平均9.9个月）随访.氨甲环酸组患者术后6、24及72 h血红蛋白下降率（0.09％±0.06％、0.16％±0.06％、0.25％±0.05％）显著低于对照组患者（0.12％±0.06％、0.23％±0.05％、0.34％±0.05％）,术后24 h引流量[（216.97±101.39） mL]、隐性失血量[（566.84±258.68） mL]、总失血量[（909.36 ±267.43）mL]显著少于对照组患者[（598.40±104.15）、（671.71±319.55）、（1 189.72±306.99） mL],差异均有统计学意义（P＜0.05）,而两组患者的术后纤维蛋白原、凝血酶原时间、活化部分凝血酶原时间及输血率比较差异均无统计学意义（P＞0.05）.随访期间两组无一例患者发生症状性DVT、PE等并发症. 结论 TKA中关节腔内使用氨甲环酸能显著减少患者术后失血量,且不会增加术后DVT及PE的发生率.
Objective To investigate the efficacy and safety of using tranexamic acid in articular cavity to decrease blood loss after total knee arthroplasty （TKA）.Methods From June 2013 to May 2014,60 patients receiving TKA were divided into 2 even groups （n=30）.In observation group,1g tranexamic acid in 20 mL physiological saline was injected into the articular cavity of each patient after the joint capsules were sutured.Meanwhile,30 patients in the control group received injection of only 20 mL physiological saline.After TKA,closed drainage was carried out for 3 hours.The 2 groups were observed and compared in terms of hemoglobin at 6 h,24 h and 72 h postoperation,activated partial thromboplastin time （APTT）,fibrinogen （FIB）,prothrombin time （PT）,drainage volume at 24 h postoperation,hidden blood loss,total blood loss,and transfusion rate.Meanwhile,both groups were observed for incidence of deep vein thrombosis （DVT） and pulmonary embolism （PE）.Results The 2 groups obtained an average follow-up of 9.9 months （from 6 to 17 months）.The decreases in hemoglobin at 6 h,24 h and 72 h postoperation in the observation group （0.09% ±0.06%,0.16% ±0.06% and 0.25% ±0.05%） were significantly lower than those in the control group （0.12% ±0.06%,0.23% ±0.05% and 0.34% ±0.05%）;the drainage volume at 24h postoperation （216.97 ± 101.39 mL）,hidden blood loss （566.84 ± 258.68 mL）,and total blood loss （909.36 ±267.43 mL） in the former were also significantly lower than in the latter （598.40 ± 104.15 mL,671.71 ± 319.55 mL and 1,189.72 ± 306.99 mL respectively） （P 〈 0.05）.There were no significant between-group differences in FIB,PT,APTT or transfusion rate （P 〉 0.05）.No DVT or PE was observed in the follow-ups in either group.Conclusion Use of tranexamic acid in the articular cavity for patients after TKA can significantly decrease blood loss and blood transfusion rate,increasing no risk of DVT and PE.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2015年第5期395-398,共4页
Chinese Journal of Orthopaedic Trauma
关键词
氨甲环酸
关节成形术
置换
膝
手术后出血
栓塞和血栓形成
Tranexamic acid
Arthroplasty,replacement,knee
Postoperative hemorrhage
Embolism and thrombosis
