静脉联合局部应用氨甲环酸对单侧全膝关节置换围术期出血量影响及安全性评估  

Effect of Intravenous and Topical Application of Tranexamic Acid on Bleeding Amount in the Perioperative Period of Unilateral Total Knee Replacement and its Safety Evaluation

作　　者：赵良虎[1] 刘典锋[1] 黄金[1] 刘汉涛[1] 

机构地区：[1]攀枝花学院附属医院,四川攀枝花617000

出　　处：《风湿病与关节炎》2015年第10期14-16,20,共4页Rheumatism and Arthritis

基　　金：四川省教育厅重点课题(11ZA255)

摘　　要：目的:观察静脉联合局部应用氨甲环酸对单侧全膝关节置换术术中、术后出血量、输血量、血红蛋白值及凝血功能的影响并对其安全性加以评估。方法:将86例初次行单侧全膝关节置换术的患者随机分为治疗组和对照组,每组43例。治疗组在假体安装完成缝合开始时,给1 g氨甲环酸配入100 m L生理盐水静脉滴注;膝关节假体安装完缝合关节囊后,再给1 g氨甲环酸稀释于50 m L生理盐水注入关节腔内;术后3 h再次静脉滴入1 g氨甲环酸。对照组给予等量生理盐水静脉滴注。比较两组术中出血量、术后可见失血量、输血量、输血人数及术后血红蛋白值、术后纤维蛋白原、凝血酶原时间等检测结果;术后观察患者是否出现下肢深静脉栓塞的临床症状,术后1周行常规下肢深静脉多普勒超声检查。结果:两组术中失血量比较,差异无统计学意义(P>0.05),但术后失血量、输血量、输血人数比较,治疗组均明显低于对照组(P<0.05);术后血红蛋白值比较,治疗组明显高于对照组(P<0.05);两组术前和术后3 h纤维蛋白原、凝血酶原时间和活化部分凝血活酶时间比较,差异无统计学意义(P>0.05);术后1周下肢深静脉血栓形成率比较,差异无统计学意义(P>0.05)。结论:局部及联合静脉应用氨甲环酸在全膝关节置换术中及术后,能明显降低患者的术后失血量及输血量等,具有良好的止血效果且不增加静脉血栓形成的风险。Objective：To explore the effect of intravenous and topical application of tranexamic acid on amount of bleeding and blood transfusion,content of hemoglobin and blood coagulation in the perioperative period of unilateral total knee replacement and its safety evaluation.Methods：86 patients who would undergo unilateral total knee replacement were randomly divided into a treatment group and a control group,43 cases in each.Patients of the treatment group were given intravenous drip of tranexamic acid （ 1 g ） and physiological saline （ 100 mL ） while stitching after prosthesis installation and given tranexamic acid （ 1 g ） and physiological saline （ 50 mL ） into the joint cavity after suturing the joint capsule.After 3 hours of replacement,they were again given intravenous infusion of 1 g tranexamic acid.Patients in the control group were given the same amount of normal saline.Compared intraoperative blood loss,postoperative blood loss,blood transfusion,blood donors,postoperative hemoglobin,postoperative fibrinogen and prothrombin time of the two groups.Postoperative observation of patients was made for the possibility of deep venous embolism in lower limb.One week after operation,Doppler ultrasound for the deep vein was made.Results：The difference of blood loss between the twogroups was not statistically significant （ P 〉 0.05 ） ,but the postoperative bloodloss,blood transfusion and blood donors of the treatment group were significantly less than of the control group （ P 〈 0.05 ） .The postoperative hemoglobin value of the treatment group was significantly higher than that of the control group （ P 〈 0.05 ） .The differences of fibrinogen,prothrombin time and activation time of partial thromboplastin between the two groups were not statistically significant （ P 〉 0.05 ） .The difference of deep vein thrombosis formation rate in lower extremity between the two groups was not statistically significant （ P 〉 0.05 ） after one week of operation.Conclusion：Intravenous and

关 键 词：全膝关节置换术 静脉 凝血时间 氨甲环酸 失血量 

分 类 号：R687.4[医药卫生—骨科学]