全膝关节置换应用氨甲环酸有效性和安全性的研究  

Efficiency and safety of tranexamic acid in application of total knee arthroplasty

作　　者：林崇明[1] 刘卓[1] 吴献伟[1] 

机构地区：[1]莆田学院附属医院骨科,福建351100

出　　处：《齐齐哈尔医学院学报》2016年第36期4485-4487,共3页Journal of Qiqihar Medical University

摘　　要：目的探讨在初次单侧全膝关节置换中应用氨甲环酸的有效性和安全性。方法 2014年7月至2015年7月80例行初次单侧全膝关节置换的骨关节炎患者随机分为两组,分别为关闭切口前静脉滴注生理盐水(A组)、关闭切口前静脉滴注氨甲环酸10 mg/kg(B组),每组40例。比较两组术后24 h引流量、总失血量、显性失血量、隐性失血量、术后不同时间血红蛋白、输血患者比例、深静脉血栓和肺栓塞发生率。结果 A组术后24 h引流量(379.6±43.6)ml,大于B组(213.6±50.3)ml,差异有统计学意义(P<0.05)。A组总失血量(1 130.8±356.4)ml,大于B组(876.4±264.5)ml,差异有统计学意义(P<0.05)。但隐性失血量的差异无统计学意义(P>0.05)。A组术后第1、5天的血红蛋白均低于B组,差异有统计学意义(P<0.05)。两组输血患者比例分别为20.0%(8/40)和5%(2/40),A组高于B组,差异有统计学意义(P<0.05)。两组术后监测均未出现症状性深静脉血栓和肺栓塞。结论全膝关节置换术中在关闭切口前静滴氨甲环酸10 mg/kg,能有效减少患者围手术期失血量和降低输血患者的比例,并且未增加患者发生深静脉血栓和肺栓塞的风险。Objective To explore the efficiency and safety of Tranexamic Acid（TXA） in application of unilateral primary total knee arthroplasty（TKA）.Methods A total of 80 patients with knee osteoarthritis,undergoing unilateral primary TKA from July 2014 to July 2015 were randomly divided into two groups（n = 40 foreach group）.Patients in group A received physiological saline via fast intravenous infusion before closing the incision：patients in group B received 10 mg/kg TXA via fast intravenous infusion before closing the incision.The draining volume within postoperative24 h,total blood loss,external blood loss,hidden blood loss,the postoperative hemoglobin concentration at different times,the numher of patients need blood transfusion and incidence rates of postoperative deepvein thrombosis rate and pulmonary embolism were compared in the two groups.Results The blood loss via drainage was significantly less in the B group（213.6 ± 50.3 ml） compared with the A group（379.6±43.6ml）（P〈0.05）：the total blood loss was significantly less in the B group（876.4±264.5ml） compared with the A group（1130.8± 356.4ml）（P〈0.05）：there was no differences about the hidden blood loss among the two groups（P〉0.05）.The hemoglobin concentration was significantly higher in the B group than in the A group in day 1 and 5 postoperation（P〈0.05）.The ratio of transfusion was significantly less in the B group than in the A group（P〈0.05）.There was no DVT in all of the two groups within 5 days postoperation,and there was no symptomatic DVT and PE in all of the two groups.Conclusions TXA intravenous infusion before closing the incision in application of TKA can effectively reduce the volumes of postoperative draining volume,total blood loss and external blood loss and increase the postoperative hemoglobin level.

关 键 词：氨甲环酸 全膝关节置换 有效性和安全性 

分 类 号：R687.4[医药卫生—骨科学]