氨甲环酸不同给药方案对全髋关节置换类风湿关节炎患者预后的影响  

Effects of Different Dosage Medications of Tranexamic Acid on Prognoses of Patients with Rheumatoid Arthritis Undergoing Total Hip Replacement

作　　者：吴焘[1] 张国秋[1] 张广源[1] 曹志强[1] 

机构地区：[1]青海大学附属医院骨科,西宁810001

出　　处：《解放军医药杂志》2016年第7期86-91,共6页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：青海省科技厅项目(2014-2J-749)

摘　　要：目的探讨不同氨甲环酸给药方案对行全髋关节置换术(THA)的类风湿关节炎(RA)患者的影响。方法回顾性分析2012年4月—2015年1月行THA的RA 156例的临床资料,根据氨甲环酸给药情况分为研究1组52例、研究2组56例和对照组48例。研究1组于术前30 min和术后6 h均静脉滴注氨甲环酸,研究2组于术前30 min静脉滴注氨甲环酸,对照组术前30 min及术后6 h均静脉滴注生理盐水。观察3组围术期失血情况,记录手术前后血红蛋白(Hb)水平及围术期Hb最大减少值;分析手术前后手术侧肢体周径差值及凝血指标变化情况,记录术后2周内深静脉血栓(DVT)发生率。结果研究1、2组术中失血量、术后失血量、输血率和输血量均少或低于对照组,且研究1组术后失血量、输血率及输血量均少或低于研究2组(P<0.05)。研究1、2组显性红细胞丢失量和隐性红细胞丢失量少于对照组,且研究1组少于研究2组(P<0.05)。3组术后24 h血红蛋白水平均低于术前,但研究1、2组高于对照组,研究1组高于研究2组(P<0.05);围术期血红蛋白最大减少值研究1、2组低于对照组,且研究1组低于研究2组(P<0.05)。3组术后24 h凝血酶原时间、活化部分凝血活酶时间均短于术前(P<0.05)。3组手术前后手术侧肢体周径差值及DVT发生率比较差异无统计学意义(P>0.05)。结论在THA围术期内予以氨甲环酸静脉滴注能有效改善RA患者术中及术后失血量,且术后血栓事件发生风险较低,患者预后良好。Objective To investigate effect of difference dosage medications of Tranexamic Acid on prognoses of patients with rheumatoid arthritis （RA） undergoing total hip arthroplasty （THA）. Methods Clinical data of 156 RA patients undergoing THA during April 2012 and January 2015 was retrospectively analyzed, and all the patients were di-vided into study group I （n=52）, study group Ⅱ （n=56） and control group （n=48） according to Tranexamic Acid dosage medications. Study group I was injected with Tranexamic Acid intravenously 30 min before operation and 6 h after operation;study group Ⅱ received Tranexamic Acid by intravenous drips 30 min before operation;control group was in-jected with normal saline intravenously 30 min before operation and 6 h after operation. In three groups, perioperative conditions of blood loss were observed, preoperative and postoperative hemoglobin （ Hb） levels and Hb maximum de-crease value during operation were recorded;different values of surgical side body circumference and changes of coagula-tion indexes before and after operation were analyzed, and incidence rates of deep venous thrombosis （ DVT） within post-operative 2 weeks were recorded. Results Values of perioperative and postoperative blood loss volume, blood transfu-sion rate and blood transfusion volume in study group I andⅡwere less than those in control group, and values of postop-erative blood loss volume, blood transfusion rate and blood transfusion volume in study group I were less than those in study group Ⅱ （P〈0. 05）. Loss values of dominant and recessive erythrocytes in study group I and Ⅱ were less than those in control group, and the values in study group I were less than those in study group Ⅱ （P〈0. 05）. Hb levels 24 h after operation were significantly lower than those before operation in three groups, and the levels in study group I and Ⅱ were higher than that in control group, and the level in study group I was higher than that in study groupⅡ（ P〈0. 05）;Hb maxi

关 键 词：氨甲环酸 关节炎 类风湿 关节成形术 置换 髋 失血 手术 深静脉血栓 

分 类 号：R593.22[医药卫生—内科学]