初次髋关节置换患者氨甲环酸不同给药途径比较的前瞻性研究  

Comparison of different modes of tranexamic acid administration in primary total hip arthroplasty: a prospective study

作　　者：黄勇[1] 刘俊宾[1] 房好林[1] HUANG Yong;LIU Jun-bin;FANG Hao-lin(Department of Joint and Traumatology,Jining No.1 People's Hospital,Jining,Shandong,272011,China)

机构地区：[1]济宁市第一人民医院关节创伤外科,山东272011

出　　处：《中国骨与关节杂志》2018年第12期885-890,共6页Chinese Journal of Bone and Joint

摘　　要：目的验证口服氨甲环酸的临床止血效果是否优于静脉与局部用药途径。方法将初次接受全髋关节置换术的患者以数字表法随机分为口服组(术前2 h服用氨甲环酸2 g),静脉组(切皮前5 min按20 mg/kg静滴氨甲环酸),局部组(3 g氨甲环酸溶于150 ml生理盐水局部应用)。主要观察指标为血红蛋白下降值,次要指标为出血量、输血率、住院时间、氨甲环酸费用、不良事件以及术后凝血功能变化。结果三组患者人口统计学特征相似,血红蛋白下降值:口服组(34.6±13.2) g/L,静脉组(35.4±10.7) g/L,局部组(36.5±12.6) g/L,三组差异无统计学意义(P>0.05)。失血量:口服组(1004±415) ml,静脉组(1032±350) ml,局部组(1064±410) ml,三组差异无统计学意义(P>0.05)。输血例数,口服组4例,静脉组5例,局部组7例,三组差异无统计学意义(P>0.05)。住院天数,口服组(5.43±0.95)天,静脉组(5.58±1.17)天,局部组(5.41±0.72)天,三组差异无统计学意义(P>0.05)。费用,口服400元,静脉组3300元,局部组3550元,三组差异有统计学意义(P<0.05)。不良事件本研究三组没有出现深静脉血栓、肺栓塞或者感染等事件。凝血功能三组间变化值差异无统计学意义(P>0.05)。结论在止血效果上,口服氨甲环酸可以与静脉注射和局部应用氨甲环酸相媲美,因口服氨甲环酸费用成本更低、更易于操作。Objective To determine whether oral administation of tranexamic acid (TXA)is superior to intravenous or topical routines. Methods All patients undergoing primary THA were randomized to oral group (2 g TXA orally 2 hours preoperatively), intravenous group (20 mg/kg intravenous TXA bolus 5 minutes before the incision), and topical group (3 g TXA applied topically). Reduction of hemoglobin, blood loss, transfusion rate, hospital stay, cost of TXA, adverse events, and coagulation functions were observed. Results Demographic characteristics were similar among the 3 groups. The mean reduction of hemoglobin: oral group (34.6±13.2)g/L; intra-venous group (35.4±10.7)g/L; topical group (36.5±12.6)g/L; with no statistically significant differences (P>0.05). Blood loss: oral group (1004±415)ml; intra-venous group (1032±350)ml; topical group (1064±410)ml; with no statistically significant differences (P>0.05). Transfusion rate (case): oral group 4; intra-venous group 5; topical group 7; with no statistically significant differences (P>0.05). Hospital stay: oral group (5.43±0.95)days; intra-venous group (5.58±1.17)days; topical group (5.41±0.72)days; with no statistically significant differences (P>0.05). Costs: oral group 400 yuan; intra-venous group 3300 yuan; topical group 3550 yuan; with statistically significant differences (P<0.05). No deep venous thrombosis, pulmonary embolism, or infection was observed. There were no significant differences in the coagulation functions among the 3 groups (P>0.05). Conclusions Blood-sparing efficacy of oral TXA is comparable to that of the intravenous and topical routines. Oral TXA is recommended by its cost-benefit superiority and ease of administration.

关 键 词：氨甲环酸 关节成形术 置换 髋 投药 口服 投药 局部 投药 静脉内 前瞻性研究 

分 类 号：R687.4[医药卫生—骨科学]