氨甲环酸控制膝关节置换术后失血的临床研究  

The Clinical Research of Joint Application of Tranexamic Acid on Postoperative Blood Loss in Total Knee Arthroplasty

作　　者：赵毓军[1] 王小铁[1] 

机构地区：[1]晋城煤业集团总医院骨二科,山西晋城048006

出　　处：《实用骨科杂志》2016年第5期417-420,共4页Journal of Practical Orthopaedics

摘　　要：目的临床观察膝关节置换术关节腔内注射氨甲环酸术后出血量,评估在膝关节置换术中局部使用氨甲环酸对减少出血及降低输血率的有效性。方法收集2013年3月至2015年3月因重度退变性骨关节炎行膝关节置换术的患者共154例,采用随机分组的方法,78例在手术松止血带前关节腔内注射氨甲环酸0.5 g+50 m L生理盐水(氨甲环酸组),76例患者注射50 m L生理盐水(对照组),两组患者术后当日引流管常规夹闭2 h,评估两组患者总失血量、术中失血量、术后引流量、不显性失血量、术后第1天及第3天血红蛋白降低程度、术后输血率、术后下肢肿胀程度、术后1周内膝关节功能康复情况。结果通过比较发现氨甲环酸组的总失血量、术后引流量、不显性失血量、术后3 d血红蛋白含量降低程度、术后输血率、膝关节周围皮肤瘀斑的面积及下肢肿胀程度较对照组明显减小(P<0.05),但两组患者在术中出血量上差异无统计学意义(P>0.05)。结论膝关节置换术关节腔内注射氨甲环酸并结合短期夹闭引流管,能有效地减少术后引流量及降低输血率,且不增加并发症的发生。Objective To study postoperative blood loss in total knee replacement（ TKR） using intra-articular application of tranexamic acid（ IA-TXA） and to evaluate the effectiveness in conventional TKR on blood loss and blood transfusion reduction. Methods Between 2013 and 2015,a randomized controlled study was conducted in 154 patients undergoing conventional TKR because of severe osteoarthritis. The patients were allocated into two groups according to intra-articular solution received： study group（ TXA 500 mg with 50 m L saline,78 cases） and control group（ 50 m L saline,76 cases）. The solution was injected after wound closure followed by drain clamping for 2 hours. The patients were assessed by maximum blood loss,intraoperative blood loss,wound drainage,hidden blood loss,decrease of hemoglobin level at 1 d and 3 d after operation,degree of lower limbs swelling,the condition of lower limb function recovery between the two groups. Results The statistical differences were detected between the two groups in terms of total blood loss,wound drainage,hidden blood loss,decrease of hemoglobin level at 3 d,the rate of transfusion,the sizes of ecchymosis and the degree of lower limbs swelling（ P〈0. 05）. Intraoperatve blood loss was non-significant difference between groups（ P〉0. 05）. Conclusion Topical tranexami acid combined with temporary clamping of drain could reduce postoperative blood loss and transfusion without significant difference in complication.

关 键 词：膝关节置换 氨甲环酸 出血量控制 

分 类 号：R687.42[医药卫生—骨科学]