氨甲环酸与膝关节置换术后失血的相关研究  

RELATION STUDIES OF EFFECT OF TRANEXAMIC ACID ON BLOOD LOSS ASSOCIATED WITH TOTAL KNEE ARTHROPLASTY

作　　者：万磊[1] 李宜照[1] 彭梦瑶[1] 

机构地区：[1]日照市人民医院,山东日照276800

出　　处：《牡丹江医学院学报》2014年第2期26-28,共3页Journal of Mudanjiang Medical University

摘　　要：目的:探讨氨甲环酸对减少全膝关节置换术后出血量的影响。方法:2010-01~2013-12期间,选取98例行全膝关节置换术患者,男52例,女46例,年龄55岁~78岁,平均62.5岁。病因:骨性关节炎62例,类风湿性关节炎24例,创伤性关节炎12例。病程2a^12a。随机分为两组(A组51例,B组47例),A组在松止血带前30min将氨甲环酸1g稀释于100mL的生理盐水后按1mL/kg静脉点滴;B组仅给予等量的生理盐水静脉点滴,记录术中和术后的失血量及输血量,观察患者是否出现深静脉栓塞的临床症状;术前、术后6h和术后24h检查,凝血酶原时间(Prothrombin time,PT)、活化的部分凝血活酶时间(activated partial thromboplastin time,APTT)。结果:A组和B组术中出血量为0;术后引流量分别为A组210±165mL,B组579±196mL,差异均有统计学意义(P<0.05),A组未输血,B组的输血量分别为400±76mL(P<0.05);术后连续复查血红蛋白浓度,B组为0.6~0.8g/dL,低于A组的1.02~1.08g/dL。术后获随访6~12个月,经血管超声多普勒检查均未发现下肢深静脉血栓的形成。两组间PT和APTT比较差异无统计学意义(P>0.05)。结论:在全膝关节置换术中及术后短期使用氨甲环酸能明显减少患者失血量及输血量,并且不增加静脉血栓形成的危险。Objective：To investigate the effect of tranexamic acid on blood loss associated with total knee arthroplasty （TKA）. Methods： From January 2010 to December 2013, 98patients （52 males, 46 females ; aged 55 - 78 years, averaged 62.5 years） underwent TKA. there were 98 patients, 62 with osteoarthritis, 24 with rheumatoid arthritis, and 12 with traumatic arthritis. The illness course ranged from 2 to 12 years. They were randomily divided into Group A of 51 patients,Group B of 47 patients. The patients in Group A received tranexamic acid , and the patients in Group B received an equal volume of normal saline. In Group A, 1 g of tranexamic acid dissolved in 100 mL of normal saline was intravenously infused before 30 minutes deflation of the tourniquet; Group B, only 100 mL of normal saline was infused intravenously. The amounts of blood loss and blood transfusion during operation and after operation in all the 98 patients were recorded. They were also observed whether they had deep vein thrombosis, and activated partial thromboplstin time were also examined before operation, during operation （ deflation of the tourniquet）, and 6 and 24 hours after operation. Results：The blood loss was 210 ± 165 mL in Group A and 579 ± 196 mL in Group B; there were significant differences between the two groups（ P 〈 0.05 ）. The postoperative hemoglobin concentration was higher in Group A than that in Group B（ 1.02 ± 1.08g/dL vs 0.6 ± 0.8g/dL）. The postoperative follow - up for 6 - 12 months revealed that no deep vein thrombosis was found in both lower limbs of the patients by the color Doppler ultrasonography. There were no significant differences in the levels of pmthrombin time, and activated partial thromboplastin time between the two groups （ P 〉 0.05 ）. Conclusion： During and after TKA operation, a short - term use of tranexamic acid can significantly decrease blood loss and blood transfusion with no increasing risk for venous thrombosis.

关 键 词：全膝关节置换术 氨甲环酸 对比研究 

分 类 号：R68[医药卫生—骨科学]