氨甲环酸应用方式对膝关节置换围手术期失血量影响对照研究  

Prospective comparative research on the blood loss after total knee arthroplasty between single dose intraarticular injection of tranexamic acid and during operation and postoperative injection of tranexamic acid

作　　者：华政哲[1] 张敬东[1] 韩文峰[1] 何勇[1] 张攀[1] 孙保飞 

机构地区：[1]沈阳军区总医院骨科,辽宁沈阳110016

出　　处：《创伤与急危重病医学》2016年第1期36-39,共4页Trauma and Critical Care Medicine

摘　　要：目的评价术中股骨髓腔创面应用氨甲环酸止血结合关闭切口后经引流管膝关节腔内单次灌注应用氨甲环酸止血,与关闭切口后经引流管膝关节腔内单次灌注应用氨甲环酸止血,对膝关节置换围手术期失血量的影响。方法前瞻性研究分析沈阳军区总医院骨科自2014年1月至2015年1月收治的68例因膝关节骨性关节炎行单侧全膝关节置换术患者,根据应用氨甲环酸方式分为两组。A组患者34例,关闭切口后经引流管膝关节腔内单次灌注氨甲环酸2.5 g(25 ml)止血;B组患者34例,术中股骨髓腔创面应用1.0 g(10 ml)氨甲环酸注射后,使用截骨块封闭股骨髓腔,结合关闭切口后经引流管膝关节腔内单次灌注1.5 g(15 ml)氨甲环酸止血。比较两组患者手术时间、术后引流量、术后血红蛋白变化和总失血量。结果两组患者年龄、性别、体质量指数(BMI)、术前出血时间、术前血浆凝血酶原时间(PT)、术前活化部分凝血活酶时间(APTT)、术前血小板计数比较,差异均无统计学意义。两组患者术前血红蛋白比较,差异无统计学意义;术后24 h,A组血红蛋白为(11.2±0.9)g/L,B组为(11.9±0.8)g/L,两组间比较,差异有统计学意义(P<0.05);术后48 h,A组血红蛋白为(10.5±1.0)g/L,B组为(11.3±0.6)g/L,两组间比较,差异有统计学意义(P<0.05)。A组术后引流量为(320.5±21.0)ml,B组为(260.9±18.7)ml,B组明显低于A组,差异有统计学意义(P<0.01)。A组总失血量(962.0±43.6)ml,B组总失血量(780.0±42.3)ml,B组明显低于A组,差异有统计学意义(P<0.01)。两组手术时间比较,差异无统计学意义。两组患者术后均未发生假体周围感染、下肢深静脉血栓或其他并发症。结论膝关节置换术中股骨髓腔创面应用氨甲环酸止血,结合关闭切口后经引流管膝关节腔内局部灌注应用氨甲环酸止血,效果更好,且未增加手术时间、假体周围感染及静脉血栓形成的风险。Objective To compare the efficiency of single dose intra-articular injection of tranexamic acid（ TXA） and during operation and postoperative injection of tranexamic acid on the blood loss after total knee arthroplasty（ TKA）.Methods A total of 68 patients with osteoarthritis of knee joint,who were performed TKA,were prospective analyzed. Due to the TXA control method,patients were random divided into two groups including single dose intra-articular injection of tranexamic acid group（ Group A） and in operation and postoperative injection of tranexamic acid group（ Group B）. In Group A,2. 5 g tranexamic acid was intra-articular injected after skin suture.In Group B,1. 0 g tranexamic acid was injected to femoral medullary cavity in operation,and the other 1. 5 g tranexamic acid was intra-articular injected after skin suture.All operations in the two groups were performed by the same surgeon,and the same knee joint prosthesis.The data of hemoglobin,operation time,drainage blood and total blood loss after TKA were analyzed.Results There were no significant difference between two groups with respect of age,gender,body mass index.At 24 hours postoperatively,the hemoglobin in Group A was（ 11. 2±0. 9） g/L,and（ 11. 9± 0. 8） g/L in Group B,and there was significant difference between the two groups.At 48 hours postoperatively,the hemoglobin of Group A was（ 10. 5±1. 0） g / L,and that was（ 11. 3± 0. 6） g / L in Group B,and there was significant difference between the two groups. The postoperative drainage volume was（ 320. 5 ± 21. 0） ml in Group A and（ 260. 9±18. 7） ml in Group B,and there was significant difference between the two groups（ P〈0. 01）.The total blood loss was（ 962. 0±43. 6） ml in Group A and（ 780. 0± 42. 3） ml in Group B,and there was also significant difference between the two groups（ P 0. 01）. No case suffered from deep vein thrombosis and other complications in both groups. Conclusion Combined with intraoperative and postoperative injection of tra

关 键 词：氨甲环酸 失血量 膝关节置换 关节腔灌注 静脉血栓 

分 类 号：R683.42[医药卫生—骨科学]