术中氨甲环酸局部浸泡对人工全膝关节置换围手术期失血量的影响  

Evaluation of Tranexamic Acid solution local soaking on reducing blood loss in total knee arthroplasty

作　　者：吴博[1] 王岩[2] 张国强[2] 倪明[2] 李想[2] 孔祥朋 

机构地区：[1]第三军医大学,重庆市400038 [2]解放军总医院,北京100853

出　　处：《临床药物治疗杂志》2016年第4期39-42,共4页Clinical Medication Journal

摘　　要：目的:评价手术切口浸泡氨甲环酸对人工膝关节置换术围手术期失血量的影响。方法:采用随机的方法,将2010年8月至2011年4月符合收入标准的需行单侧全膝关节置换术的连续200例患者分为氨甲环酸组和对照组;其中氨甲环酸组97例患者在止血带释放前、假体植入后切口浸泡浓度为1%的氨甲环酸溶液100 m L共5 min,对照组103例患者局部浸润生理盐水100 m L,两组患者的年龄、性别、体质量指数、假体类型、止血带使用时间均无显著性差异(P>0.05)。观察记录两组患者的术前血红蛋白值和术后血红蛋白最低值、术前和术后HSS评分以及术后24 h引流量和总出血量。在术后必要时B超检查双下肢动静脉有无血栓形成。结果:随访率98%,在总出血量、引流量、术后血红蛋白最低值、术前血红蛋白与术后最低值之差方面,氨甲环酸组与对照组间均有显著性差异(P<0.01)。两组手术前后HSS改善值、下肢血管血栓发生率比较均无显著性意义。两组输血率无显著性意义,但是在输血量上两组有显著性差异(P<0.05)。结论:人工膝关节置换术中浸泡氨甲环酸可以减少失血量、引流量、手术前后血红蛋白丢失量,在改善术后血红蛋白最低值方面作用显著。可以减少输血量,但是对于对输血率改善不明显。本实验中氨甲环酸浸泡并未增加下肢深静脉血栓形成等风险。Objective：To evaluate tranexamic acid local soaking on reducing blood loss in total knee arthroplasty. Methods： In this clinical trial, 200 patients who underwent unilateral TKA in our orthopedic center between August 2010 and April 2011 were included and randomly allocated to two groups. In TXA group （n=97）, surgical site were irrigated with lg TXA in 100 ml of saline for 5 minutes after implanting the prostheses with fastening the tourniquet. In control group （n=103）, joints were irrigated with 100 mL of saline in the same way. There were no differences in the demographic factors （age,sex,BMI,prostheses type,tourniquet time） between the groups. The amount of drainage, the total blood loss, the lowest hemoglobin levels before and after operation, the pre-operative and post-operative HSS scores were all recorded. Use the ultrasound to detect the DVT if necessary. Results： The rate of follow up is 98%. There are significant difference in these indexes such as total blood loss, drainage, the lowest hemoglobin level and hemoglobin drop after operation between TXA group and control group. There were no differences in HSS scores before and after operation, DVT incidence and transfusion rates between the two groups. However, the number of transfused units of TXA group was significantly lower than that of the control group. Conclusion： In TKA, irrigation with TXA can reduce the total blood loss, drainagethe, hemoglobin drop and improve the lowest value of post-operative hemoglobin level. It could reduce the number of transfused units, but cannot reduce the transfusion rates

关 键 词：关节置换 氨甲环酸 失血量 

分 类 号：R687.4[医药卫生—骨科学]