不同剂量氨甲环酸在全膝关节置换术中的疗效比较  

Curative effect comparison among different doses of Tranexamic Acid in patients undergoing primary total knee arthroplasty

作　　者：鲁强[1] 彭昊[1] 尹东[2] 聂志刚[1] 欧阳龙[1] 朱玲[3] 许玲玉[3] 

机构地区：[1]武汉大学人民医院骨科,430060 [2]广西壮族自治区人民医院骨科 [3]广西医科大学药学院

出　　处：《临床外科杂志》2016年第4期296-298,共3页Journal of Clinical Surgery

摘　　要：目的比较不同剂量氨甲环酸在全膝关节置换术中疗效的差异。方法骨关节炎或类风湿性关节炎患者235例分为4组:60例患者松止血带前10分钟静脉滴注1 g氨甲环酸(A组),60例患者松止血带前10分钟静脉滴注10 mg/kg氨甲环酸(B组),60例患者松止血带前10分钟静脉滴注20mg/k氨甲环酸(C组),对照组55例,不给予氨甲环酸注射(对照组)。比较4组患者术中失血量、术后24小时引流量、术后血红蛋白(Hb)波动水平、输血率、深静脉血栓、肺栓塞及其他并发症情况。结果 4组患者术中失血量、输血率比较,差异无统计学意义(P>0.05),术后引流量、术后血红蛋白波动水平比较,差异有统计学意义(P<0.05),A、B、C3组术后引流量、Hb波动水平、输血率均低于对照组,差异有统计学意义(P<0.05),3组间比较差异有统计学意义(P<0.05)。A、C两组较B组能进一步减少术后失血量和改善术后Hb水平,A、C两组间比较,差异无统计学意义。术后各组均未发生深静脉血栓、肺栓塞及其他并发症。结论全膝关节置换静脉滴注氨甲环酸可有效减少术后失血量,降低术后Hb水平,与静滴10 mg/kg氨甲环酸相比,静滴1 g或20 mg/kg能进一步减少术后引流量,降低Hb水平,且不增加不良事件概率。Objective To compare the curative effect among different doses of tranexamic acid （TXA） in patients with primary total knee arthroplasty. Methods In this prospective, randomized clinical trial ,235 consecutive patients with knee osteoarthritis（OA） or rheumatoid arthritis （RA）that were candidates for TXA in our hospital were enrolled. The patients were divided into four different groups based on the regimen of TXA. TXA was infused intravenously 10 mins before tourniquet release in three groups： group A（n =60）received a single 1 g dose,group B（n = 60）received a 10 mg/kg dose and group C（n = 60） received a 10 mg/kg dose. The other 55 patients didnt infuse TXA（ control group）. Data collection ineluded intraoperative blood loss, postoperative drain output, postoperative hemoglobin levels, transfusion re- quirements, the incidence of deep vein thrombosis （DVT）and pulmonary embolism（ PE ）, and other complications. Results There were no statistically significant differences in intra - operative blood loss and transfusion requirements among the groups, while significant differences in postoperative drainage and hemoglobin levels existed. There were no significant differences between group A and C in postoperative drainage, hemoglobin levels and transfusion requirement, while both groups showed significant differences compared to the group B and control group. No episode of DVT, PE or other complications occurred in either group. Conclusion This study suggests that the application of TXA can effectively reduce the volumes of postoperative draining volume and improve postoperative hemoglobin level,and lg or 20mg/kg of TXA intravenous infusion is more effective in reducing draining and improving postoperative hemoglobin level.

关 键 词：膝关节置换术 氨甲环酸 不同剂量 失血量 

分 类 号：R687.4[医药卫生—骨科学]