局部应用氨甲环酸不放置引流对降低全膝置换隐性失血的疗效  

Topical application effect of tranexamic acid without drainage to lower the curative effect of hidden loss of blood in total knee arthoplasty

作　　者：卢道云 黄强[1] 栗景峰[2] 邹守平[1] 徐蒙[1] 叶力[1] 胡维帆 赵强[1] 

机构地区：[1]解放军第413医院骨一科,浙江舟山316000 [2]第二军医大学附属长海医院骨科,上海200433

出　　处：《临床骨科杂志》2016年第3期324-327,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨局部应用氨甲环酸、不放置引流对降低人工全膝关节置换(TKA)后隐性失血的疗效。方法选择60例行单侧TKA患者,随机分两组,A组(30例):关节腔内应用氨甲环酸,不放置引流;B组(30例):不应用氨甲环酸,放置引流。比较两组患者术中及术后失血量、隐性失血量、输液量、输血量、患肢周径变化等指标,术前和术后3 h检查D-二聚体和相关凝血指标,术后连续复查血常规。结果术中失血量两组比较差异无统计学意义(P>0.05),术后失血量和隐性失血量两组比较差异均有统计学意义(P<0.05)。两组术中输液量比较差异无统计学意(P>0.05),术后24 h输液量两组比较差异有统计学意义(P<0.05)。术后输血量A组(480 ml±140 ml)少于B组(908 ml±248 ml)(P<0.05)。术后血红蛋白和红细胞压积B组明显低于A组(P<0.05)。术后3 h的D-二聚体A组为(0.92±0.45)mg/L,B组为(1.22±0.67)mg/L,均明显高于术前的(0.36±0.12)mg/L和(0.35±0.14)mg/L(P<0.05),且B组高于A组(P<0.05)。术后凝血指标两组比较差异无统计学意义(P>0.05)。两组患肢周径变化差异均无统计学意义(P>0.05)。结论TKA中局部应用氨甲环酸、不放置引流明显减少了术后隐性失血量,同时减少了输血量和输血率,且不影响凝血功能。Objective To explore the topical application effect of tranexamic acid without drainage on reducing the hidden bleeding after total knee arthoplasty （ TKA） .Methods Sixty patients with unilateral TKA routine were ran-domly divided into two groups , group A （ n =30 ）： articular cavity application tranexamic acid without drainage;group B （ n=30）：no tranexamic acid with indwelling drainage .It was compared in two groups of patients with intra-and post-operative blood loss ,hidden blood loss , transfusion volume ,blood transfusion volume , affected limb week di-ameter change etc many indexs , pre-and post-operative 3 h D-dimer and related blood coagulation indexes , postoper-ative continuous review of routine blood .Results Intraoperative blood loss difference between the two groups had no statistical significance （P〉0.05）, postoperative blood loss and hidden blood loss difference between the two groups had statistical significance （P〈0.05）.There was no significant difference between the two groups in the intraopera-tive transfusion volume （P〉0.05）, but 24 h postoperation, the difference was statistically significant （P〈0.05）. Postoperative blood transfusion volume in group A （480 ml ±140 ml） was less than group B （908 ml ±248 ml） （ P〈0.05）.Postoperative hemoglobin concentration and red blood cells deposited for group B was lower than that in group A （P〈0.05）.Postoperative 3 h,D-dimer for group A was （0.92 ±0.45） mg/L,group B was （1.22 ±0.67） mg/L, were both significantly higher than that of the preoperative [（0.36 ±0.12） mg/L and （0.35 ±0.14） mg/L] （P〈0.05）, and group B was higher than group A （P〈0.05）.Postoperative blood coagulation index comparing differences between the two groups had no statistical significance （P〉0.05）.There was no significant difference be-tween the two groups in the changes of affected limb week diameter （P〉0.05）.Conclusions TKA in topical appli-cation of tranexamic acid , don′t place d

关 键 词：全膝关节置换 局部应用 氨甲环酸 不放引流 隐性失血 

分 类 号：R687.4[医药卫生—骨科学] R973.1[医药卫生—外科学]