摘要
目的探讨局部使用氨甲环酸(TXA)联合贮存式自体输血在减少或避免全膝关节置换术(TKA)患者术中、术后出血和围术期异体输血中的作用。方法采用前瞻性随机对照方法,纳入本院2015年1月-2016年11月因膝重度骨性关节炎接受单侧人工TKA患者75名,随机分为A组(TXA处理组:术中、术后局部使用TXA);B组(贮存自体血+TXA处理组:术前5-7 d采集300-400 mL自体血,术中或术后回输,TXA使用同A组);C组(对照组:未贮存自体血,手术过程不使用TXA)。比较3组患者手术时长,术中出血量,术后血性液体引流量,输异体血例数,术后异体输血量,总住院天数等数据。结果3组患者术中出血量(201.30±169.36 vs 214.17±178.41 vs 558.67±237.12 mL),术后血性液体引流量(198.37±58.76 vs 210.22±66.13 vs 398.17±74.75 mL),A组与B组比较,P>0.05,A、B 2组分别于C组比较,P<0.01;异体输血率3组分别为6.9%、0和33.3%,A、B组异体输血人次及数量明显低于C组。结论氨甲环酸联合自体输血等多项血液保护技术,显著减少了TKA患者的术中、术后出血与异体输血,并可缩短患者住院天数,节约大量宝贵的血液与其他医疗资源。
Objective To explore the impact of local application of tranexamic acid(TXA)combined with stored autologous blood transfusion in reducing or avoiding intraoperative and postoperative bleeding and perioperative allogeneic blood transfusion in patients with total knee arthroplasty(TKA).Methods A prospective randomized controlled study was used for patients with severe knee osteoarthritis who underwent unilateral total knee arthroplasty between January 2015 to November 2016 in our hospital.All patients were randomly divided into three groups:group A(TXA treated group:local application of TXA intraoperative and postoperative);group B(autologous blood transfusion combined with TXA treatment group:300-400 mL of autologous blood was collected 5-7 days preoperatively for intraoperative or postoperative transfusion;the same application of TXA as group A);Group C(control group:neither autologous blood transfusion nor TXA application was conducted during the operation).The data of operation time,intraoperative bleeding volume,postoperative drainage,number and volume of postoperative allogeneic blood transfusion,and total hospital stay were compared among three groups.Results The difference of volume of blood loss(201.30±169.36 vs 214.17±178.41 vs 558.67±237.12 mL)and postoperative drainage(198.37±58.76 vs 210.22±66.13 vs 398.17±74.75 mL)between group A and group B was not significant(P>0.05),however,significant difference was observed when group A/group B was compared to group C(P<0.01).Allogeneic blood transfusion rates in the three groups was 6.9%,0 and 33.3%,respectively.The number of allogeneic blood transfusion in group A and B was significantly lower than those in group C(P<0.05).Conclusion TXA combined with autologous blood transfusion significantly reduced the introoperative,postoperative bleeding and allogeneic blood transfusion in TKA patients.Futhermore,it could shorten the hospital stay and save blood and other medical resources.
作者
林茹
牛余贵
高长杰
张冠宏
LIN Ru;NIU Yugui;GAO Changjie;ZHANG Guanhong(Department of Blood Transfusion,Shengli Oilfield Central Hospital,Dongying 257034,China;Department of Joint Sur-gery,Shengli Oilfield Central Hospital,Dongying 257034,China)
出处
《中国输血杂志》
CAS
2019年第10期1011-1013,共3页
Chinese Journal of Blood Transfusion
关键词
全膝关节置换术
氨甲环酸
自体输血
围术期输血
total knee arthroplasty
tranexamic acid
allogeneic blood transfusion
preoperative transfusion
