重复使用氨甲环酸对全膝关节置换术后失血量及血栓形成的影响  

Efficacy of repeated use of tranexamic acid on blood loss and thrombosis after total knee arthroplasty

作　　者：徐闯[1] 刘明廷[1] 戚大春[1] 李贤让[1] 孟涛[1] 

机构地区：[1]滨州医学院附属医院骨关节外科,山东滨州256600

出　　处：《中国矫形外科杂志》2016年第9期800-805,共6页Orthopedic Journal of China

摘　　要：[目的]研究重复使用氨甲环酸对全膝关节置换术失血量及血栓发生率的影响。[方法]将纳入试验的75例患者随机分为三组,分别在松止血带之前静脉滴注氨甲环酸15 mg/kg(单次使用组);松止血带前单次使用及术后3 h再次按该剂量重复使用(术后3 h组);松止血带前单次使用及术后6 h再次按该剂量重复使用(术后6 h组)。比较三组术后引流量(术后24 h)、总失血量、隐性失血量、血红蛋白、输血患者比例、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体、深静脉血栓和肺栓塞发生率。[结果]单次使用组术后24 h引流量、总失血量[(305.00±76.88)ml、(921.8±203.1)ml]大于术后3 h组[(115.76±48.49)ml、(713.5±198.7)ml]及术后6 h组[(128.56±44.45)ml、(731.3±187.3)ml],差异有统计学意义(P<0.05);术后3 h组24 h引流量及总失血量小于术后6 h组,差异无统计学意义。单次使用组术后24、72 h及120 h的血红蛋白均低于术后3 h组及后6 h组,差异有统计学意义(P<0.05)。术后三组FIB、PT、APTT及D-二聚体的比较差异无统计学意义。住院期间及术后4个月均未见深静脉血栓栓塞并发症。[结论]重复剂量氨甲环酸减少TKA术后失血量且不增加血栓形成,具有有效性及安全性;氨甲环酸重复使用的最佳时点为术后3 h。[Objective] To investigate the efficacy of repeated use of tranexamic acid（ TXA） on blood loss and thrombosis after total knee arthroplasty（ TKA）. [Methods] A total of 75 patients were randomly divided into three groups,25 cases in each group. Patients received 15 mg / kg TXA by fast intravenous infusion before tourniquet release in the first group（ single dose group）. Patients in the second group received two doses of 15 mg / kg TXA before tourniquet release and 3 hours postoperation（ 3h after operation group）. Patients in the third group received two doses of 15 mg/kg TXA before tourniquet release and 6hours postoperation（ 6h after operation group）. The postoperative blood loss via drainage（ 24 hours after the operation）,the total blood loss,the hidden blood loss, fibrinogen（ FIB）, prothrombin time（ PT）, activated partial thromboplastin time（ APTT）,D- dimer,the postoperative hemoglobin concentration at different time points and the number of patients needing blood transfusion were recorded. All patients were observed for detecting deep vein thrombosis（ DVT） by the color doppler ultrasonography,and the symptomatic DVT and pulmonary embolism（ PE） were observed within 120 days postoperatively. [Results] The blood loss via drainage and total blood loss were significantly less in the 3h after operation group（ 115. 76 ± 48. 49ml、713. 5 ± 198. 7 ml） and 6h after operation group（ 128. 56 ± 44. 45ml、731. 3 ± 187. 3ml） compared with that in the single dose group（ 305. 00 ± 76. 88 ml、921. 8 ± 203. 1 ml）,there was no differences about the hidden blood loss among the three groups. The hemoglobin concentration was significantly higher in the 3h after operation group and 6h after operation group than that in the single dose group at 24,72 and 120 hours postoperatively. There were no significant differences in the levels of fibrinogen,prothrombin time,activated partial thromboplastin time and D- dimmer between two groups（ P〈0. 05）. And no deep vein throm

关 键 词：全膝关节置换术 氨甲环酸 失血量 血栓 

分 类 号：R687.4[医药卫生—骨科学]