氨甲环酸对膝关节置换术后血红蛋白降低的临床研究  

Clinical effects of knee replacement postoperative reducing hemoglobin of tranexamic acid application

作　　者：徐飞[1] 吕永明[1] 宋莺春[1] 李霞[1] 邢恩鸿[1] 杨阳[1] 杜元良[1] 张立超[1] 戴海峰[1] 董晓强[2] 何文静 张艳波 

机构地区：[1]承德医学院附属医院骨外三科,河北承德067000 [2]承德医学院附属医院承钢分院骨科,河北承德067000 [3]河北省宽城满族自治县县医院内窥镜室,河北宽城067600

出　　处：《中国临床药理学杂志》2015年第13期1246-1248,共3页The Chinese Journal of Clinical Pharmacology

基　　金：承德市科学技术研究与发展计划基金资助项目(20142060)

摘　　要：目的评价不同剂量氨甲环酸对膝关节置换术后血红蛋白降低的影响。方法 116例膝关节置换术患者随机分为试验组58例与对照组58例。2组患者的手术流程与方法一样,对照组在切皮前经静脉注射氨甲环酸50 mg·kg-1,试验组静脉注射氨甲环酸100 mg·kg-1,观察2组围手术指标(手术时间、切口长度、术中出血量、术后引流量、总输血量),血红蛋白变化和凝血四项指标。结果 2组患者均顺利完成手术出院。试验组的术中出血量、术后引流量、总输血量明显少于对照组(P<0.05)。2组术后血红蛋白含量都呈明显降低趋势(P<0.05),试验组术后的血红蛋白含量明显高于对照组(P<0.05)。2组间术前与术后的凝血四项指标差异无统计学意义(P>0.05)。术后随访3个月,试验组出现深静脉血栓(1例),急性心肌梗死(0例),一过性神经症状(1例)等并发症发生率明显低于对照组(5,3,4例)(P<0.05)。结论大剂量氨甲环酸的应用能够减少膝关节置换术术中出血量与输血量,缓解术后血红蛋白的降低,对凝血功能无影响,安全性更好。Objective To investigate the effects of knee replacement postoperative on reducing hemoglobin by the different doses of tranexamic acid application.Methods A total of 116 knee replacement patients were enrolled and divided into the treatment group and the control group,58 cases in each group.The surgical procedures and methods of the two groups were same,as patients in the control group were given intravenously before incision tranexamic acid 50 mg · kg-1,and those in the treatment group received tranexamic acid 100 mg · kg-1.During the peri-operative phase,the index of operation time,incision size,blood loss during operation,post-surgery drainage and the total number of blood transfusion,as well as hemoglobin were observed.Results Patients in two groups were all discharged after successful completion surgery.The blood loss,postoperative drainage,the total amount of blood transfusion of the treatment group were significantly less than those of control group（P 〈 0.05）.The postoperative values in the two groups were showed significantly decreased（P 〈 0.05）,but preoperative hemoglobin values of the treatment group were significantly higher（P 〈 0.05）.The data of preoperative and postoperative coagulationindicators compared between two groups showed no significant difference.Patients were followed up for 3 months.The incidence of complications of deep vein thrombosis（1 case）,acute myocardial infarction（0 case）,transient neurological symptom（1 case） in the treatment group were significantly lower than that in control group（5,3,4 cases）（P 〈 0.05）.Conclusion High dose of tranexamic acid applications can reduce blood loss and transfusion knee replacement volume,and relieve the postoperative decrease of hemoglobin,meanwhile,it has no obvious effect on coagulation function with defined security.

关 键 词：氨甲环酸 剂量 膝关节置换术 血红蛋白 

分 类 号：R973[医药卫生—药品] R687.4[医药卫生—药学]