氨甲环酸对全膝关节置换术后出血、异体输血及自体引流血回输的影响  

Effects of tranexamic acid on postoperative blood loss,allogeneic blood transfusions and autologous drainage blood transfusion in total knee arthroplasty

作　　者：韩宁[1] 姚建华[1] 黄炎[1] 孙维[1] 

机构地区：[1]北京军区总医院骨科,北京100700

出　　处：《中国输血杂志》2016年第3期242-245,共4页Chinese Journal of Blood Transfusion

摘　　要：目的探讨氨甲环酸(TXA)减少全膝关节置换术(TKA)患者围手术期出血及对自体引流血回输和术后异体输血的影响。方法采用前瞻性随机对照方法,纳入2014年6月-2015年6月本院因膝重度骨性关节炎接受单侧人工TKA患者60名,随机分为A组(处理组:术中及术后氨甲环酸15 mg/kg静滴);B组(对照组:术中及术后同等剂量0.9%生理盐水静滴)。收集对比2组患者性别、年龄、身高、体重数据,以及术前及术后Hb、Hct,手术时长,术中出血量,术后引流量,自体引流血回输量、术后异体输血量,以及输血例数,髌上10 cm周径。用Gross方程计算患者围手术期隐性出血量及总计出血量。结果 A与B组术后引流量(m L)分别为220.37±168.6 vs 598.67±234.33;隐性出血量(m L)494.67±371.08 vs 726.75±357.48及总计出血量(m L)715.03±389.06 vs 1 325.42±422.74(均为P<0.05)。A与B组的异体输血率分别为0 vs 6.7%(2/30)。A与B组自体引流血回输量(m L)30±76.76 vs 283±111.45(P<0.05)。结论氨甲环酸可减少全膝关节置换术患者的术后出血,减少术后异体输血及自体引流血回输。Objective To research the impact of Tranexamic acid （TXA） to reduce total knee arthroplasty （TKA） and on preoperative blood loss, atttologous drainage in blood transfusion and allogeneie blood transfusion. Methods A prospec- tive randomized controlled study was used for patients with severe knee osteoarthritis who underwent unilateral total knee ar- throplasty between June 2015 and June 2014 and the patients were randomly divided into two groups ： A group （treatment group receiving tranexamic acid 15 mg/kg intravenous drip） and B group （ control group and postoperative receiving equal doses of 0. 9% saline infusion）. Patients＇ gender, age, height, weight, preoperative and postoperative hemoglobin （HB） , red blood cell hematocrit （HCT）, operation time, intraoperative bleeding volume, postoperative drainage autologous drainage blood transfusion volume, postoperative blood transfusion volume and number, patellar 10 cm circumference changes were collected. The lower extremity ecchymosis after operation was described. The amount of hidden blood loss and the total a- mount of bleeding perioperative period were calculated using the Gross Equation. Results The volume of postoperative drainage（mL）, hidden blood loss（mL）, total blood loss（mL） in A group and B group were 220. 37 ± 168. 6 vs 598. 67 ±_ 234. 33,494. 67 ± 371.08 vs 726. 75 ± 357.48,715.03 ± 389.06 vs 1 325.42 ± 422.74, respectively （P 〈 0. 05）. A group did not have allogeneic blood transfusion, 2 cases in B group （6.7%） received infusion of allogeneic blood. The volume of autologous drainage（mL） in blood transfusion in A group and B group was 30 ± 76.76 vs 283 ± 111.45 （ P 〈 0. 05 ）. Conclusion Tranexamic acid can reduce bleeding in patients with total knee arthroplasty after surgery and reduce postoperative autologous blood reinfusion.

关 键 词：全膝关节置换术 围术期出血 隐性出血 自体引流血 氨甲环酸 自体输血 

分 类 号：R457.1[医药卫生—治疗学] R687.4[医药卫生—临床医学]