双侧同期全膝关节置换术患者阿司匹林结合氨甲环酸局部应用有效性与安全性的回顾研究  

Aspirin and local application of tranexamic acid reduce blood loss for simultaneous bilateral total knee arthroplasty

作　　者：顾建明[1] 潘盈[2] 杜辉[1] 蒋毅[1] 周一新[1] 

机构地区：[1]北京积水潭医院矫形骨科,100035 [2]西安交通大学第一附属医院风湿免疫科,710061

出　　处：《中国骨与关节杂志》2016年第7期545-548,共4页Chinese Journal of Bone and Joint

摘　　要：目的研究阿司匹林结合关节腔内应用氨甲环酸在减少同期双侧人工全膝关节置换术围手术期出血的有效性和安全性。方法将2012年1月至2015年1月,同期行双侧人工全膝置换术患者101例分为观察组与对照组。45例未使用氨甲环酸为对照组,使用氨甲环酸的56例为观察组。观察组患者在骨水泥固定后关节内喷洒氨甲环酸1 g(10 ml)。术后使用阿司匹林预防静脉血栓。记录两组患者的性别,男女比例,体重指数,术前血容量,术前血红蛋白水平以及血小板计数,再比较两组患者术后总失血量、有无输血、输血量以及有无症状性静脉栓塞(VTE)发生。结果氨甲环酸组和对照组在术后第1天总失血量分别为729.0 ml和1163.0 ml,术后第5天总失血量为915.8 ml和1358.2 ml,总输血量3.1 U和4.2 U,输血率为92.9%和100.0%,观察组数据显著低于对照组(P<0.05)。观察组术后第5天的血红蛋白水平(1108 g/L)明显高于对照组(982 g/L)(P<0.05)。两组患者术后血小板计数[(159.4±44.4)×109/L和(165.4±45.7)×109/L]差异无统计学意义(P>0.05)。两组患者术后均未发生症状性静脉血栓。结论同期双侧人工全膝关节置换术局部使用氨甲环酸可以有效减少出血量,且不增加血栓发生风险。Objective To investigate the effi cacy and safety of aspirin in combination with local tranexamic acid for simultaneous bilateral total knee arthroplasty. Methods From Jan. 2012 to Jan. 2015, 101 simultaneous bilateral TKA were retrospectively analyzed. Local application of tranexamic acid was given in 56 cases. Control group involved 45 cases without tranexamic acid uses. Aspirin was given for prevention of deep vein thrombosis. Total blood loss, transfusion volume, transfusion rate and venous thromboembolism were recorded and compared. Results Total blood loss in post-operative day one and fi ve, transfusion volume, transfusion rate and venous thromboembolism（ VTE） in tranexamic acid group and control group were 729.0 ml and 1163.0 ml, 915.8 ml and 1358.2 ml, 3.1 U and 4.2 U, 92.9% and 100.0% respectively, which were signifi cantly lower in tranexamic acid group. Hemoglobin level was signifi cantly higher in tranexamic acid group（ 1108 g / L） compared with control（ 982 g / L）（ P〈0.05）. There were no significant differences between platelet counting or symptomatic VTE. Conclusions Local application of tranexamic acid can signifi cantly reduce blood loss for bilateral simultaneous total knee arthroplastywithout increasing the risk of VTE.

关 键 词：氨甲环酸 关节成形术 置换 膝 人工关节 手术后出血 失血 手术 静脉血栓形成 阿司匹林 

分 类 号：R687.4[医药卫生—骨科学]