氨甲环酸在人工关节外科领域的应用  

Application of tranexamic acid in artificial joint surgery

作　　者：马金辉[1] 孙伟[2] 高福强[2] 王云亭[2] 李子荣[2] 

机构地区：[1]北京大学中日友好临床医学研究所,100029 [2]中日友好医院骨关节外科,骨坏死与关节保留重建中心,北京100029

出　　处：《中国骨与关节杂志》2014年第11期847-851,共5页Chinese Journal of Bone and Joint

基　　金：国家自然科学基金面上项目(81372013);中日友好医院院级课题(2013-MS-27);中日友好医院青年科技英才计划(2004-QNYC-A-06)

摘　　要：关节外科手术失血量一般较大,初次人工全膝关节置换术(total knee arthroplasty,TKA)后的失血量可达到1000~1790 ml[1],初次人工全髋关节置换术(total hip arthroplasty,THA)失血量更大,平均可达到1944ml[2],脊柱外科手术亦有大量出血的风险。随着外科手术技术的提高,例如小切口全髋关节置换术(minimal incision THA,MIS-THA)等骨科微创手术,以及自体血回输、术后引流血回输、急性等溶性血液稀释。Tranexamic acid （ TXA ） is economical and safe, with good hemostatic effects in joint surgery. The intravenous route is most commonly used. TXA can also be administrated orally or intra-articularly but not intrathecally or intra-cerebrally. Better hemostatic effects can be achieved both in spinal surgery and total hip arthroplasty （ THA ） with the use of TXA. TXA is generally injected intra-articularly in total knee arthroplasty （ TKA ） before the tourniquet was released and after the capsule was sutured. The patients who underwent TKA were divided into 2 groups, including one group receiving 1.5% TXA intra-articularly and the other group receiving 3.0% TXA intra-articularly. The postoperative blood loss volume was 1295 ml in the 1.5% TXA group, and 1208 ml in the 3.0% TXA group. Statistically signiifcant differences were observed between the 2 groups, and the patients receiving more TXA had less blood loss. Only the articular cavity is affected with the intra-articular administration of TXA. Such advantages as minimal systemic absorption, less intra-articular bleeding and reduced risk of deep venous thrombosis （ DVT ） and pulmonary embolism （ PE ） can be found with the intra-articular administration of TXA when compared with the intravenous administration. The intra-articular administration of TXA is superior to the intravenous administration. （ 1 ） Potential complications related to the intravenous administration of TXA can be avoided or decreased, particularly in high-risk patients, such as the patients with cardiovascular diseases, venous thromboembolism, renal dysfunction and so on. （ 2 ） The blood loss, blood transfusion and transfusion rate after TKA can be reduced with the intra-articular administration of TXA. TXA is contraindicated in the patients with a history of arterial or venous thrombosis, hematological system diseases, acute renal failure, seizures and/or hypersensitivity. Postoperative hemorrhage is caused by many factors, and the physicians should take comprehensive

关 键 词：Tranexamic acid(TXA) HEMOSTATICS Postoperative hemorrhage Joint prosthesis 

分 类 号：R687.4[医药卫生—骨科学] R973[医药卫生—外科学]