全膝关节置换术中氨甲环酸不同用药方式对围术期失血量的影响  

Effects of different administration methods of tranexamic acid on perioperative blood loss of total kneearthroplasty

作　　者：王利[1] 米尔阿里木·木尔提扎 袁宏[1] 

机构地区：[1]新疆维吾尔自治区人民医院骨科中心关节外科,乌鲁木齐830001

出　　处：《中国医药》2017年第2期276-280,共5页China Medicine

基　　金：新疆维吾尔自治区人民医院院内科研项目（20150204）

摘　　要：目的比较全膝关节置换术中氨甲环酸不同用药方式对围术期失血量的影响。方法选取2014年1月至2015年12月于新疆维吾尔自治区人民医院关节外科接受单侧全膝关节置换术的患者90例。完全随机分为安慰剂组、关节腔注射组、静脉注射组，各30例。其中静脉注射组又根据给药时机不同完全随机分为切皮前给药组、装假肢前给药组、关伤口时给药组，各10例。分别以不同方式及时机给予氨甲环酸治疗。比较各组患者止血带使用时间、异体输血比例、术后总引流量、总失血量、隐性失血量及并发症发生率的差异。结果所有患者均顺利完成手术。静脉注射组、关节腔注射组和安慰剂组间止血带使用时间、异体输血比例差异无统计学意义（P〉0．05）。静脉注射组和关节腔注射组患者术后总引流量、总失血量、隐性失血量小于安慰剂组，差异有统计学意义[（195±80）、（158±92）ml比（348±105）m1，（770±125）、（898±105）ml比（1068±114）ml，（353±104）、（449±124）ml比（592±154）ml]（P〈0．05）；且静脉注射组总失血量、隐性失血量小于关节腔注射组，差异有统计学意义（P〈0．05）。关伤口时给药组、装假体前给药组术后总引流量、总失血量、隐性失血量大于切皮前给药组，差异有统计学意义[（192±74）、（208±79）ml比（178±68）ml，（761±135）、（784±136）ml比（739±129）ml，（359±119）、（356±118）ml比（348±116）ml]（P〈0．05）。关节腔注射组与静脉注射组并发症发生率差异无统计学意义（P〉0．05）。结论氨甲环酸于切皮前静脉给药较其他方式更能明显减少围术期失血量，而不增加血栓形成风险。Objective To compare effects of different administration methods of tranexamic acid on perioperative blood loss of total knee arthroplasty（TKA）. Methods A total of 150 patients undergoing TKA were enrolled in Xinjiang Uiger Municipal people＇s Hospital from January 2014 to December 2015. The patients were randomly divided into 3 groups according to different administration methods of tranexamie acid： placebo group （without tranexamie acid） , intra-artieular injection group and intravenous injection group, with 30 cases in each group. The intravenous injection group was divided into 3 subgroups with 10 cases in each group according to different drug administration time; group A was administrated before incision ; group B was administrated before fitting artificial knee joint; group C was administrated before suture. Tourniquet using time, allogeneic blood transfusion rate, postoperative total drainage volumes, total blood loss, hidden blood loss and complication rate were compared among groups. Results Operations were finished in all patients. Tourniquet using time and allogeneic blood transfusion rate had no significant differences among placebo group, intra-articular injection group and intravenous injection group （ P 〉 0.05 ）. Postoperative total drainage volumes, total blood loss and hidden blood loss in intravenous injection group and intra-articular injection group were less than those in placebo group [（195±80）,（158±92）ml vs （348 ±105）ml; （770±125）,（898±105）nd vs （1 068 ±114）ml; （353± 104 ） , （449 ± 124 ）ml vs （592 ± 154 ）ml ] ; the total blood loss and hidden blood loss in intravenous injection group were less than those in intra-artieular injection group; the differences were statistically significant （P 〈 0. 05 ）. Total drainage volumes, total blood loss and hidden blood loss in group B, C were more than those in group A [（192±74）,（208±79）mlvs （178±68）ml; （761±135）,（784±136）mlvs （739±129）ml;（359±119）, �

关 键 词：全膝关节置换术 氨甲环酸 静脉注射 关节腔注射 

分 类 号：R684[医药卫生—骨科学]