全膝关节置换术中静脉与局部应用氨甲环酸止血效果比较  

Comparison of hemostatic effect of tranexamic acid in intravenous and topical application in total knee arthroplasty

作　　者：田野[1] 吴兴凯[1] 董立明[1] 

机构地区：[1]遵义医学院附属医院关节外科,贵州遵义563000

出　　处：《临床骨科杂志》2017年第2期179-181,184,共4页Journal of Clinical Orthopaedics

摘　　要：目的比较在初次行单侧全膝关节置换(TKA)术中静脉与局部应用氨甲环酸(TXA)的止血效果。方法将380例初次行单侧TKA患者按照应用TXA方式及不应用TXA分成3组:1静脉滴注组:术中静脉滴注TXA 30 mg/kg,120例;2局部注射组:将1.5 g TXA溶入50 ml生理盐水中,术中关节腔内多点注射,136例;3不应用组:术中不应用TXA,124例。术前及术后第1、2、3天连续测量术侧肢体周径,对术中失血量、术后引流量、输血情况、深静脉血栓形成(DVT)等情况进行观察。结果患者均获得随访,时间12~18个月。3组手术时间、术中失血量、术后引流量、异体血输注量、DVT及术侧肢体周径比较差异均无统计学意义(P>0.05);输血率、术后隐性失血量、失血总量:静脉滴注组、局部注射组均明显低于不应用组,差异有统计学意义(P<0.05),静脉滴注组与局部注射组比较差异无统计学意义(P>0.05)。结论在初次行单侧TKA中,静脉及局部应用TXA均有良好的止血效果,能明显减少患者的出血量,且不增加DVT的风险。两种用法之间无明显差异。Objective To compare the hemostatic effect of intravenous and topical tranexamic acid（ TXA） in primary unilateral total knee arthroplasty（ TKA）. Methods According to the application with or without TXA,the 380 cases underwent primary unilateral TKA were divided into three groups ： 1 the intravenous drip group： intraoperative intravenous infusion of TXA 30 mg/kg,with a total of 120 cases; 2 local injection group： 1. 5 g TXA was dissolved in 50 ml normal saline,intraoperative intra-articular injection point,136 cases; 3 no application group： no TXA used during surgery,with 124 cases. The limb circumference were measured preoperatively and postoperatively at 1,2 and 3d,the blood loss,postoperative drainage volume,blood transfusion and deep venous thrombosis（ DVT） were observed. Results All patients were followed up for 12 - 18 months. Three groups of operation time,blood loss,postoperative drainage,allogeneic blood transfusion,DVT and operative limb circumference showed no significant difference（ P〈0. 05）. the rate of blood transfusion,hidden blood loss,the total volume of postoperative blood loss： intravenous drip group,local injection group were significantly lower than that of no application group,the differences were statistically significant（ P〈0. 05）. Intravenous drip group and local injection group had no significant difference（ P〉0. 05）. Conclusions In the first unilateral TKA,intravenous and local application of TXA have good hemostatic effect,which can significantly reduce the bleeding volume in patients,and do not increase the risk of DVT.There are no significant differences between the two routes of administration.

关 键 词：氨甲环酸 全膝关节置换术 止血 

分 类 号：R687.4[医药卫生—骨科学] R973.1[医药卫生—外科学]