氨甲环酸用于全膝关节置换降低失血量的有效性及安全性  

Tranexamic acid reduces blood loss in total knee arthroplasty:effectiveness and safety

作　　者：曹万军[1] 朱绍灵[1] 刘显东[1] 唐承杰[1] 郑金文[1] 陈星宇[1] 刘颖[1] 肖鹏[1] 

机构地区：[1]四川省骨科医院下肢科,四川省成都市610041

出　　处：《中国组织工程研究》2015年第31期4944-4948,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:氨甲环酸是一种人工合成的抗纤维蛋白溶解的药物,可以经静脉有效的控制全膝关节置换后失血。目的:观察氨甲环酸对初次行单侧全膝关节置换患者置换后失血的有效性及安全性。方法:选取2014至2015年在四川省骨科医院下肢科行单侧全膝关节置换的100例患者。以使用氨甲环酸与否分为试验组和对照组,各50例。试验组患者在全膝关节置换前10 min静脉注射氨甲环酸1 g,而对照组不给予氨甲环酸。结果与结论:试验组患者置换后围手术期总失血量、置换后24 h引流量、输血量明显少于对照组(P<0.05);试验组与对照组术中出血量、输血人数差异无显著性意义。两组患者患者置换前血红蛋白水平差异无显著性意义,而置换后血红蛋白水平均下降,且试验组患者置换后血红蛋白水平均明显高于对照组。置换后24 h,两组患者凝血功能差异无显著性意义。置换后6 d,2组患者双下肢静脉彩色多普勒超声检查均未见深静脉血栓。提示初次单侧全膝关节置换前静脉给予氨甲环酸能明显减少围手术期失血量及输血量,降低输血风险及输血费用,利于术后功能恢复,且不增加下肢深静脉血栓的风险。BACKGROUND：Tranexamic acid is a synthetic anti-fibrinolytic drug, and can effectively control blood loss after total knee arthroplasty through vein. OBJECTIVE：To evaluate the effectiveness and safety of tranexamic acid in reducing blood loss after primary unilateral total knee arthroplasty. METHODS：From 2014 to 2015, 100 patients from the Department of Lower Limb, Sichuan Orthopaedic Hospital underwent primary unilateral total knee arthroplasty, and randomly divided into test group which used tranexamic acid and control group which used tranexamic acid, with 50 cases in each group. 1 g tranexamic acid was infused into the vein at 10 minutes before total knee arthroplasty in the test group, but tranexamic acid was not given in the control group. RESULTS AND CONCLUSION：The amount of total blood loss, postoperative wound drainage in 24 hours, and the amount of blood transfusion were significantly less in the test group than in the control group （P 〈 0.05）. No significant differences in intraoperative blood loss and the number of patients receiving blood transfusion were found between the test and control groups. No significant difference in preoperative hemoglobin levels was detected before surgery, but hemoglobin levels were decreased after surgery between the two groups. Postoperative hemoglobin levels were apparently higher in the test group than in the control group after surgery. At 24 hours after surgery, no significant difference in coagulation was detectable between the two groups. At 6 days, double lower limb vein color Doppler ultrasound examination did not reveal deep vein thrombosis in both groups. These findings verify that treatment with tranexamic acid in the vein before primary unilateral total knee arthroplasty can evidently diminish the amount of perioperative blood loss and blood transfusion, reduce the risknbsp;and cost of blood transfusion, which is good for rehabilitation and does not increase the risk of deep vein thrombosis.

关 键 词：植入物 人工假体 氨甲环酸 全膝关节置换 失血量 深静脉血栓 输血 

分 类 号：R318[医药卫生—生物医学工程]