氨甲环酸对全髋关节翻修术患者术后静脉血栓形成风险的影响  

Effect of tranexamic acid on risk of venous thrombosis after operation in patients undergoing revision total hip arthroplasty

作　　者：王开伟[1] 张辉[1] 张加强[1] 孟凡民[1] 

机构地区：[1]郑州大学人民医院麻醉科,450003

出　　处：《中华麻醉学杂志》2013年第7期795-798,共4页Chinese Journal of Anesthesiology

基　　金：河南省科技厅资助项目（122300410408）

摘　　要：目的 评价氨甲环酸对全髋关节翻修术患者术后静脉血栓形成风险的影响.方法 择期全麻下行全髋关节翻修术患者56例,性别不限,年龄35 ～ 64岁,体重指数20 ～ 25 kg/m2,ASA分级Ⅰ级或Ⅱ级,采用随机数字表法,将患者分为2组（n=28）：对照组（C组）和氨甲环酸组（T组）,T组气管插管后静脉注射氨甲环酸15 mg/kg,随后以10 mg·kg-1·h-1速率静脉输注至术毕,C组给予等容量生理盐水.分别于术前、术毕、术后6h及术后24h时采集静脉血样,测定血常规及凝血功能指标.记录术中出血量、自体血回收量、术后24h内引流量和异体输血情况.术后7d行下肢彩色多普勒超声检查,记录下肢深静脉血栓形成的发生情况.结果 与C组比较,T组术中出血量、自体血回收量和术后24h内引流量均减少,异体输血率降低,术毕及术后各时间点Hb和Hct均升高（P＜0.05）,活化部分凝血酶原时间、凝血酶原时间和纤维蛋白原差异无统计学意义（P＞0.05）.C组和T组下肢深静脉血栓形成发生率分别为18％和14％,组间比较差异无统计学意义（P＞0.05）.结论 术中静脉注射氨甲环酸15 mg/kg负荷量,随后以10 mg·kg-1·h-1速率静脉输注不增加全髋关节翻修术患者术后静脉血栓的形成.Objective To evaluate the effect of tranexamic acid on the risk of venous thrombosis after operation in patients undergoing revision total hip arthroplasty.Methods Fifty-six ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 35-64 yr,with body mass index of 20-25 kg/m2,scheduled for elective revision total hip arthroplasty,were randomly divided into 2 groups （n =28 each）：control group （group C） and tranexamic acid group （group T）.After induction of anesthesia,the patients were tracheally intubated and mechanically ventilated.After intubation,tranexamic acid 15 mg/kg was injected intravenously followed by infusion at a rate of 10 mg·kg-1 ·h-1 in group T,while the equal volume of normal saline was given instead of tranexamic acid in group C.Before operation,at the end of operation,and at 6 and 24 h after operation,venous blood samples were obtained for routine blood test and for determination of parameters of coagulation.The intraoperative blood loss and blood salvage,volume of drainage within 24 h after operation and transfusion of allogeneic blood were recorded.The development of venous thrombosis in the lower extremity was recorded with Doppler ultrasound on 7th day after operation.Results Compared with group C,the intraoperative blood loss and blood salvage,volume of drainage within 24 h after operation and transfusion of allogeneic blood were significantly reduced,and hemoglobin and hematocrit were increased at the end of operation and different time points after operation （P ＜ 0.05）,and no significant changes were found in activated partial thromboplastin time,prothrombin time and fibrinogen in group T （P ＞ 0.05）.The incidence of venous thrombosis in the lower extremity was 18％ and 14％ in C and T groups,respectively,and there was no significant difference between the two groups （P ＞ 0.05）.Conclusion Tanexamic acid infused at a rate of 10 mg· kg-1 · h-1 after a loading dose of 15 mg/kg injected during operation dose not increase the risk of venous thrombosis afte

关 键 词：氨甲环酸 静脉血栓形成 关节成形术 置换 髋 

分 类 号：R687.4[医药卫生—骨科学]