摘要
目的探讨在人工全膝关节置换术 (total knee arthroplasty,TKA) 围术期多次口服氨甲环酸 (tranexamic acid,TXA) 对围术期出血量、输血风险及静脉血栓的发生率等方面的影响。方法前瞻性选取 2017 年 1 月至 2019 年 1 月在我院骨一科住院行 TKA 的 120 例为研究对象,按随机数字表法分为观察组及对照组,每组各 60 例。对照组在切皮前 5~10 min 予以 1 g TXA 静脉滴注 1 次,术后 6 h、12 h、18 h 各予以1 次 1 g 静脉滴注;观察组在术前 2 h 口服 TXA 2 g,术后 4 h、10 h、16 h 分别口服 TXA 2 g。观察并记录两组术后 1 天和术后 3 天血红蛋白 (hemoglobin,Hb) 与血细胞比容 (hematocrit,Hct) 的变化情况、Hb 降低值、Hct 降低值及两组引流量、总失血量、术中失血量、隐性失血量、输血率、静脉血栓发生率。结果术后 1 天 Hb:观察组 (111.22±12.13) g / L,对照组 (110.18±11.83) g / L;术后 3 天 Hb:观察组 (98.87±8.08) g / L,对照组 (101.58±8.75) g / L;术后 1 天 Hct:观察组 (34.98±2.77) %,对照组 (34.67±4.56) %;术后 3 天 Hct:观察组 (28.33±4.15) %,对照组 (29.55±3.19) %;Hb 降低值:观察组 (29.19±16.42) g / L,对照组 (26.30±18.17) g / L;Hct 降低值:观察组 (10.47±5.55) %,对照组 (9.00±4.73) %,两组比较差异无统计学意义 (P>0.05)。引流量:观察组 (116.52±26.42) ml,对照组 (115.40±30.13) ml;总失血量:观察组(449.25±80.78) ml,对照组 (456.73±96.70) ml;术中失血量:观察组 (113.59±30.26) ml,对照组 (115.69±20.30) ml;隐性失血量:观察组 (234.87±44.76) ml,对照组 (235.37±33.01) ml;输血率:观察组 1 例(1.67%),对照组 2 例 (3.33%);静脉血栓发生率:观察组 1 例 (1.67%),对照组 0 例 (0.00%),两组比较差异无统计学意义 (P>0.05)。结论在 TKA 围术期多次口服 TXA 与多次静脉使用 TXA 在减少围术期出血量、输血风险及静脉血栓的发生率等方面效果相当。
Objective To explore effects of perioperative oral tranexamic acid (TXA) on the bleeding,transfusion risk,and venous thrombosis of total knee arthroplasty (TKA).Methods A total of 120 TKA patients were selected as the study object from January 2017 to January 2019.All were divided into the observation group(n=60) and control group (n=60) according to the random number table.Patients of the control group were given1 g intravenously TXA 5-10 minutes before skin incision,and 1g intravenously TXA 6,12 and 18 hours after operation.Patients of the observation group were given 2 g oral TXA 2 hours before operation,and 2 g oral TXA 4,10 and16 hours after operation.The Hb and Hct on the first and third day after operation,Hb reduced value,Hct reduced value,drainage volume,total blood loss,intraoperative blood loss,hidden blood loss,transfusion rate,and venous thrombosis were observed and recorded.Results The Hb on the first day:observation group (111.22±12.13) g / L,control group (110.18±11.83) g / L;the Hb on the third day:observation group (98.87±8.08) g / L,control group (101.58±8.75) g / L;the Hct on the first day:observation group (34.98±2.77) %,control group (34.67±4.56) %;the Hct on the third day:observation group (28.33±4.15) %,control group (29.55±3.19) %;Hb reduced value:observation group (29.19±16.42) g / L,control group (26.30±18.17) g / L;Hct reduced value:observation group (10.47±5.55) %,control group (9.00±4.73) %;no statistically significant differences were observed (P > 0.05).Drainage volume:observation group (116.52±26.42) ml,control group (115.40±30.13) ml;total blood loss:observation group (449.25±80.78) ml,control group (456.73±96.70) ml;intraoperative blood loss:observation group (113.59±30.26) ml,control group (115.69±20.30) ml;hidden blood loss:observation group (234.87±44.76) ml,control group (235.37±33.01) ml;transfusion rate:1.67% in the observation group (n=1),3.33% in the control group (n=2);venous thrombosis:1 patient in the observation group (1.67%);no statistically significant differences were observed (P > 0.05).Conclusions Oral and intravenous TXA achieve similar effects on perioperative bleeding,transfusion,and venous thrombosis in TKA.
作者
魏荣
赵勉
郑崇明
WEI Rong;ZHAO Mian;ZHENG Chong-ming(Department of Orthopedics,The Third People’s Hospital of Yibin,Yibin,Sichuan,644000,China)
出处
《中国骨与关节杂志》
CAS
2020年第10期786-790,共5页
Chinese Journal of Bone and Joint
关键词
关节成形术
置换
膝
氨甲环酸
围手术期
输血
静脉血栓栓塞
Arthroplasty
replacement
knee
Tranexamic acid
Perioperative period
Blood transfusion
Venous thromboembolism
