氨甲环酸联合肾上腺素减少单侧全膝关节置换术后出血的有效性及安全性研究  

Efficacy and Safety of Tranexamic Acid Plus Epinephrine on Reducing Postoperative Blood Loss After Unilateral Total Knee Arthroplasty

作　　者：魏国[1] 梁杰[1] 李玉鹏[1] 吴琼娅[1] 陈剑锋[1] 

机构地区：[1]三峡大学人民医院骨科,湖北省宜昌市443000

出　　处：《中国全科医学》2016年第3期327-331,共5页Chinese General Practice

摘　　要：目的探讨氨甲环酸(TXA)联合肾上腺素减少单侧全膝关节置换术(TKA)后出血的有效性及安全性。方法按照随机、双盲原则,选取2014年5月—2015年4月在三峡大学人民医院骨科初次行单侧TKA且符合纳入与排除标准的患者96例为研究对象。采用随机数字表法将患者分为试验组(n=48)和对照组(n=48)。试验组向关节腔内注射TXA和肾上腺素;对照组向关节腔内注射TXA。比较两组患者手术时间、术中止血带使用时间、术后3 d血红蛋白(Hb)下降值、术后3 d血细胞比容(Hct)下降值、术后3 d D-二聚体水平、总出血量、术后引流量、隐性出血量、异体输血率、大腿周经变化率、小腿周经变化率、下肢静脉血栓(DVT)发生率、皮下瘀斑面积>1%发生率。随访3个月,观察是否发生症状性DVT。结果术后3个月的门诊及电话随访未发现症状性DVT。两组患者手术时间、术中止血带使用时间、术后3 d D-二聚体水平、异体输血率、DVT发生率比较(P>0.05)。试验组患者术后3 d Hb下降值、术后3 d Hct下降值、总出血量、术后引流量、隐性出血量、大腿周经变化率、小腿周经变化率、皮下瘀斑面积>1%发生率均小于对照组(P<0.05)。结论 TXA联合肾上腺素减少单侧TKA后出血的疗效明显且安全。Objective To evaluate the efficacy and safety of tranexamic acid plus epinephrine on reducing postoperative blood loss after unilateral total knee arthroplasty （TKA） . Methods According to the principle of being randomized and double - blind, 96 patients who underwent unilateral TKA for the first time in Department of Orthopaedic of People＇s Hospital of China Three Gorges University from May 2014 to April 2015 and met the inclusion and exclusion criteria were enrolled in this study. All the patients were divided into the trial group （ n = 48 ） and the control group （ n = 48 ） by random number table method. The trial group was treated with injection of tranexamic acid plus epinephrine into the knee joint cavity. The control group was treated with only injection of tranexamic acid into the knee joint cavity. Comparison was made between the two groups in surgical duration, intraoperative tourniquet time, the decrease of hemoglobin （Hb） and hematocrit （Hct） at postoperative 3 d, D - dimer at postoperative 3 d, total blood loss, postoperative total drainage volume, hidden blood loss, the number of patients who took allogeneic blood transfusion, the change rates of thigh and calf girths, the incidence of deep vein thrombosis （DVT） and the incidence of subcutaneous ecchymosis area 〉 1%. The patients were followed up for 3 months, and were observed whether they suffered from the symptomatic DVT. Results No symptomatic DVT was found during the clinic and telephone follow -up within 3 months after operation. There were no statistically significant differences in surgical duration, intraoperative tourniquet time, D - dimer at postoperative 3 d, the number of patients who took allogeneic blood transfusion, the incidence of DVT （P 〉 0.05 ） . The decrease in Hb and Hct at postoperative 3 d, total blood loss, postoperative total drainage volume,hidden blood loss, the change rates of thigh and calf girths, the incidence of subcutaneous ecchymosis area 〉 1% in trial group were significantly low

关 键 词：氨甲环酸 肾上腺素 膝关节 人工全膝关节置换术 手术后出血 

分 类 号：R473.6[医药卫生—护理学]