摘要
[目的]探讨氨甲环酸不同给药途径对全膝关节置换术失血量的影响。[方法]120例拟行初次单侧全膝关节置换术患者,随机分为A、B、C、D四组,每组30例。A组在缝合关节囊后经引流管向关节腔内灌注溶于50ml生理盐水的氨甲环酸(tranexamic acid,TXA)1 g;B组术前0.5 h静滴TXA 20 mg/kg+100 ml生理盐水;C组关闭关节囊前关节周围软组织注射TXA 1 g+100 ml生理盐水;D组在缝合关节囊后向关节腔内灌注50 ml生理盐水。记录围手术期失血量、输血量、输血率、术后血红蛋白浓度和术后3 h纤维蛋白原、凝血酶原时间、活化部分凝血活酶时间、皮下瘀斑、深静脉血栓形成、患膝周径变化率等指标。[结果]A、B、C三组和D组两两比较,围手术期失血量、输血量和输血率明显减少,差异有统计学意义(P<0.05),A、B、C三组组间比较差异无统计学意义(P>0.05);术后血红蛋白浓度A、B、C三组明显高于D组(P<0.05),A、B、C三组组间比较差异无统计学意义(P>0.05);四组患者术后3 h纤维蛋白原、凝血酶原时间和活化部分凝血活酶时间比较差异无统计学意义(P>0.05)。A、B、C三组皮下瘀斑率和患膝周径变化率低于D组,差异有统计学意义(P<0.05)。术后未发现下肢深静脉血栓形成及肺梗塞、心肌梗塞、脑梗塞等血栓相关事件发生。[结论]在全膝关节置换术中应用TXA能明显减少围手术期失血量,降低输血率和输血量,尤其是关节腔内灌注TXA既可以减少失血又可以避免静脉给药可能带来的并发症。
[ Objective] To evaluate the effect of different administration route of tranexamie acid （TXA） on the amount of blood loss in total knee arthroplasty （TKA） . [Methods] One hundred and twenty patients who would receive unilateral TKA were randomly divided into the A, B, C and D groups with 30 patients in each group. TXA was used in different ways as follows： lg TXA dissolved in 50 ml normal saline was intraarticularly infused as soon as the capsular wound closed in the Group A, TXA in 20 mg/kg in 100 ml normal saline was intravenously injected 0.5 h before operation in the Group B, l g TXA dissolved in 100ml normal saline was infiltrated into the intraarticular soft tissue before closing the capsule in theGroup C, by contrast, 50ml of pure normal saline without TXA was injected into the joint cavity after suturing joint capsule in the Group D. The amount of blood loss, volume of infused blood, rate of blood transfusion, postoperative hemoglobin concentration, fibrinogen concentration at 3 hours postoperatively, prothromhin time, activated partial thromboplastin time, ecchymosis, deep vein thrombosis, and the chang- ing of knee circumference were documented and compared among the groups. [Results] Comparing with the group D, the re- maining 3 groups administrated TX A including the Group A, B and C showed significant diminishes in the amount of periopera- tire blood loss, volume of infused blood as well as the rate of blood transfusion （P 〈 0.05）, however there were no significant dif- ferences in any of the above mentioned criteria among the Group A, B and C （P 〉 0.05） . The postoperative hemoglobin in group A, B, C were significantly higher than that in group D （P〈0.05）, whereas no remarkable differences were notieed among the Group A, B and C （P〉0.05） . The differences in the fibrinogen at 3 hours postoperatively, prnthrombin time and activated par- tial thromboplastin time wcre not statistically significant among all of the 4 groups （P〉0.05）.Theincidenceofecchymosisand variation of knee. circumference in the Group A, B and C were significant lower than the Group D, nevertheless no deep vein thrombosis and related events was found in any of the 120 patients. [Conclusions] Tranexamic acid does significantly reducethe amount of perioperative blood loss, volume of infused blood and the rate of blood transfusion, lntra-articular ap- plication of tranexamie acid can not only reduce theamount of blood loss but also avoid complications brought by intravenous administration.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2017年第12期1096-1101,共6页
Orthopedic Journal of China
关键词
全膝关节置换术
氨甲环酸
血栓相关事件
显性失血
隐性失血
total knee arthroplasty, tranexamic acid （TXA） , thrombus related events, visible blood loss, hidden blood loss
