氨甲环酸在初次单侧TKA围手术期应用的有效性及安全性研究  

The Efficacy and Safety of Tranexamic Acid to Reduce Blood Loss of Total Knee Arthroplasty

作　　者：安帅[1] 乐国平[1] 张明[1] An Shuai Le Guoping Zhang Ming(Department of Joint and Bone Disease,4th Hospital of Guangxi Medical University, Liuzhou 545000, Chin)

机构地区：[1]广西医科大学第四附属医院关节骨病科,广西柳州545000

出　　处：《实用骨科杂志》2016年第10期888-891,共4页Journal of Practical Orthopaedics

摘　　要：目的通过对初次单侧全膝关节表面置换(total knee arthroplasty,TKA)围手术期应用氨甲环酸的临床观察,明确氨甲环酸是否既可减少围手术期失血量而又不增加术后深静脉血栓和肺栓塞的发生率。方法通过前瞻性随机选择初次单侧TKA患者实验组30例,对照组30例。两组术后均按指南进行规范的抗凝治疗,对术中失血量、术后引流量、深静脉血栓(deep vein thrombosis,DVT)、肺栓塞(pulmonary embolism,PE)的发生率进行组间两两比较。结果对照组术中失血量(58.3±20.3)m L,多于实验组(54.5±15.1)m L,差异无统计学意义(P=0.668)。对照组术后引流量(370.0±171.9)m L,多于实验组(145.9±137.9)m L,差异有统计学意义(P=0.01)。对照组显性失血量(428.3±177.7)m L,多于实验组(200.5±136.4)m L,差异有统计学意义(P=0.01)。实验组与对照组输血人数及输血比率差异有统计学意义(P<0.05)。术后第1天实验组Hb下降幅度较对照组术后第1天小,差异有统计学意义(P=0.028);术后第3、5天实验组和对照组Hb下降幅度差异无统计学意义。两组患者术后14 d、1个月、3个月均未发现下肢深静脉血栓、肺栓塞和严重出血事件。结论初次单侧全膝关节置换术围手术期应用氨甲环酸,可有效控制术后失血量,降低输血率,同时不增加术后DVT和PE的发生率。Objective The total knee arthroplasty（ TKA） peri-operative application of Tranexamic Acid,clear Tranexamic Acid can reduce perioperative blood loss without increasing postoperative deep vein thrombosis（ DVT） and pulmonary embolism（ PE）. Methods In a prospective,randomly selected primary unilateral TKA patients in experimental group in 30 cases and30 cases in the control group. Two groups were treated according to the guidelines for anticoagulant therapy,the intraoperative blood loss,postoperative drainage,deep vein thrombosis（ DVT）,pulmonary embolism（ PE） prevalence rate were compared between the two groupsResults In the control group,intraoperative blood loss（ 58. 3 ± 20. 3） m L,more than the experimental group（ 54. 5 ± 15. 1） m L,there was no statistically significant difference（ P = 0. 668）. The control group has postoperative drainage of（ 370 ± 171. 9） m L,which was more than the experimental group（ 145. 9 ± 137. 9） m L,the difference was statistically significant（ P = 0. 01）. The control group had a blood loss of（ 428. 3 ± 177. 7） m L,which was more than the experimental group（ 200. 5 ± 136. 4） m L. The difference was statistically significant（ P = 0. 01）. The experimental group and the control group of blood transfusion and transfusion rate difference was statistically significant（ P〈0. 05）. The first day after operation,the experiment group HB decreased compared with the control group. The difference was statistically significant（ P = 0. 028）.3、5 days after operation,Hb decrease between the groups had no statistical significance. was no lower extremity deep vein thrombosis,pulmonary embolism and serious bleeding events were not found 14 days,1 month,3 months after operation. Conclusion Primary unilateral total knee arthroplasty in the peri-operative application of tranexamic acid,can effectively control postoperative blood loss,reduce blood transfusion rate,also does not increase postoperative DVT and PE.

关 键 词：氨甲环酸 全膝关节表面置换 血栓 

分 类 号：R687.42[医药卫生—骨科学]