氨甲环酸联合利伐沙班在全膝关节置换术围术期中的应用效果  

Clinical Efficacy and Safety of Tranexamic Acid Combined with Rivaroxaban in Preventing Perioperative Complications in Patients Receiving Total Knee Arthroplasty

作　　者：邢国宽[1] 刘喜凤[2] 苑佳琦 陈光[1] 

机构地区：[1]廊坊市人民医院骨科,河北廊坊065000 [2]廊坊市人民医院外科,河北廊坊065000

出　　处：《医学综述》2017年第17期3511-3515,共5页Medical Recapitulate

基　　金：廊坊市科学技术研究与发展计划(2014013130)

摘　　要：目的评价氨甲环酸联合利伐沙班在全膝关节置换术(TKA)围术期中的应用效果。方法纳入2011年6月至2016年9月于廊坊市人民医院行TKA的患者100例,采用随机数字法将患者分为试验组和对照组各50例。试验组术中静脉滴注氨甲环酸1 g,局部应用氨甲环酸1 g灌注;术后12 h口服利伐沙班15 mg,每日1次,连用2周;对照组不应用氨甲环酸,术后12 h给予低分子肝素钠2 500 U皮下注射,连用2周。术后观察两组患者的出血量、术后引流量,血红蛋白(Hb)及血细胞比容(Hct)、输血量、深静脉血栓(DVT)发生率;严重出血事件发生率;临床相关非大出血发生率。结果试验组术中失血量、术后引流量、总出血量、输血量少于对照组[(267±89)mL比(478±81)mL,(272±77)mL比(354±61)mL,(1 091±251)mL比(1 279±242)mL,(543±188)mL比(655±176)mL](P<0.01),输血率低于对照组[8.0%(4/50)比24.0%(12/50),P<0.05];两组术后5 d内Hb均有先下降后上升的趋势,术后第3天最低,试验组下降程度明显小于对照组;两组术后5 d内Hct也有先下降后上升的趋势,术后第3天最低,第1和5天稍高,两组Hb和Hct在组间、时点间比较差异有统计学意义(P<0.01),两组在组间·时点间比较差异无统计学意义(P>0.05)。术后两组DVT发生率比较差异无统计学意义(P>0.05),两组切口渗血、血肿、皮下瘀斑发生率比较差异无统计学意义(P>0.05),两组术后均无严重的出血事件发生,无感染、肺栓塞等严重并发症及不良反应。结论 TKA围术期采用氨甲环酸联合利伐沙班干预并结合有效的预防措施,可减少围术期的失血量,预防术后DVT形成,减少并发症发生。Objective To investigate the application effect of tranexamic acid ＇combined with rivaroxaban in patients with receiving total knee arthroplasty（TKA）. Methods A total of 100 patients underwent TKA in Langfang People＇s Hospital from Jun. 2011 to Sep. 2016 were randomly selected and divided into a trial group and control group,50 cases each. Both groups were receiving the same clinical nursing treatment. The patients in the trial group were treated with intravenous infusion of tranexamic acid 1 g,local application of tranexamic acid 1 g perfusion;after 12 h oral administration of rivacapine 15 mg/time, 1 time/d, once every 2 weeks, the control group was not given tranexamic acid. After 12 h, low molecular weight heparin was injected subcutaneously （2 500 U） for 2 weeks. After the surgery, the hemoglobin （ Hb）, hematocrit （ Hct）, blood transfusion, the incidence of deep venous thrombosis （DVT） were observed;the incidence of severe bleeding and incidence of clinical non - major bleeding were observed. Results The blood loss, postoperative drainage, total blood loss and blood transfusion of the trial group were significantly less than those of the control group [ （267 ± 89） mL vs （478 ± 81） mL,（272±77） mL vs （354±61） mL,（1 091±251） mL vs （1 279±242） mL,（543±188） mL vs （655±176） mL] （P 〈 0.01 ）, blood transfusion rate was lower than that of the control group [ 8.0% （4/50） vs 24.0% （ 12/50 ）, P 〈 0.05 ]. The levels of Hb in the two groups decreased at the first 5 days after operation, and the lowest in the trial group was significantly lower than that in the control group;Hct also decreased on the first day and then decreased in the two groups within 5 days after operation,reaching the lowest at the third day after operation,and slightly higher on the 1st and 5th day,there was significant difference between groups and time points （P 〈 0.01 ）. There was no significant difference between groups and time points interaction（P 〉 0.05 �

关 键 词：全膝关节置换术 围术期并发症 氨甲环酸 利伐沙班 

分 类 号：R619.1[医药卫生—外科学]