摘要
[目的]探讨不同途径应用氨甲环酸(TXA)在人工全膝关节置换术(TKA)的治疗效果和安全性。[方法]选取2016年7月~2019年3月在本院拟行TKA的180例患者为研究对象,随机分成4组,每组45例。术前1 h所有患者静脉滴注TXA,10 mg/kg溶于0.9%氯化钠注射液100 ml;于术毕时静脉给药组给予TXA 1g静脉滴注,局部浸泡组给予切口处TXA 1 g溶液浸泡5 min,关节留滞组给予TXA 1 g关节腔内留置2 h,空白对照组给予相同剂量的生理盐水静脉滴注。对比四组失血相关资料、凝血参数及术后并发症发生率。[结果]四组术中出血量差异无统计学意义(P>0.05);在隐性失血量、术后总引流量、总失血量、输血量方面,从少到多依次为关节留滞组、局部浸泡组、静脉给药组和空白对照组,差异有统计学意义(P<0.05)。术后四组患者的Hb和Hct均较术前显著降低,差异均有统计学意义(P<0.05)。术前四组间Hb和Hct的差异均无统计学意义(P>0.05),而术后Hb和Hct从小到大依次为空白对照组、静脉给药组、局部浸泡组和关节留滞组,差异有统计学意义(P<0.05)。术前与术后比较,四组患者的INR、PT和APTT无显著变化(P>0.05)。相同时间点,四组间INR、PT和APTT的差异均无统计学意义(P>0.05)。四组患者术后愈合良好,无感染、坏死、肺栓塞及DVT等术后并发症发生。[结论]应用TXA可明显减少TKA术的失血,其作用与用药途径相关。本研究四种用药途径中,局部关节腔留滞的止血效果最好,且安全性好。
[Objective] To investigate the efficacy and safety of tranexamic acid(TXA) by different ways for bleeding control in primary total knee arthroplasty(TKA). [Methods] A total of 180 patients who were undergoing primary TKA in our hospital from July 2016 to March 2019 were enrolled into this study and randomly divided into 4 groups with 45 patients in each group. All patients in the 4 groups were intravenously given TXA10 mg/kg in100 mL of normal saline at 10 min before operation.In addition, at the end of operation the patients in the intravenous group received another intravenous TXA 1 g in 100 mL of normal saline, those in the local soaking group had the incision immersed by TXA 1 g in 100 ml of normal saline for 5 min, those in the retaining group had TXA 1 g in 100 mL of normal saline injected into closed capsule for 2 hours until opening the drainage,whereas those in the block control group received intravenously normal saline in the same volume only. The blood loss related data, coagulation parameters and incidence of postoperative complications were compared among the 4 groups. [Results] There were no significant differences in obvious blood loss among the 4 groups(P>0.05). However, the hidden blood loss, total drainage volume, total blood loss and volume of transfusion were ranked down-up as follows: the retaining group < soaking group <intravenous group < block control group, which proved statistically significant(P<0.05). Regarding to laboratory tests, the hemoglobin(Hb) and hematocrit(Hct) significantly decreased after operation in all the 4 groups compared with those before operation(P<0.05). Despite of no statistically significant differences among the 4 group before operation(P>0.05), the Hb and Hct were ranked down-up after operation in sequence of the block control group < intravenous group < soaking group < retaining group,which were statistically significant(P<0.05). In term of coagulation indicator, no significant changes were found in INR, PT and APTT before and after operation in all the 4 grou
作者
金成浩
蔡迎
JIN Cheng-hao;CAI Ying(Department of Orthopaedics,Teda Hospital of Tianjin City,Tianjin 300457,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2020年第5期420-424,共5页
Orthopedic Journal of China
关键词
氨甲环酸
人工全膝关节置换术
出血控制
安全性
tranexamic acid(TXA)
total knee arthroplasty(TKA)
bleeding control
safety
