促红细胞生成素联合应用铁剂和氨甲环酸对减少全膝关节置换术围术期失血效果的研究  

Clinical effects of erythropoietin combined with iron and tranexamic acid on perioperative blood loss in total knee arthroplasty

作　　者：雷一霆 黄强[1] 曹国瑞[1] 张少云[1] 徐彬[1] 裴福兴[1] LEI Yi-ting;HUANG Qiang;CAO Guo-rui;ZHANG Shao-yun;XU Bin;PEI Fu-xing(Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China)

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国骨与关节杂志》2017年第12期894-898,共5页Chinese Journal of Bone and Joint

基　　金：2013年度卫生行业科研专项项目(201302007)

摘　　要：目的评价全膝关节置换术(total knee arthroplasty,TKA)在加速康复模式下,促红细胞生成素(erythropoietin,EPO)联合铁剂改善贫血与多次使用氨甲环酸(tranexamic acid,TXA)减少围术期失血的临床效果。方法回顾分析2014年5月至2017年1月,行TKA手术患者1540例的临床资料,根据相关血液管理方案分为3组,A组:单次静脉应用联合局部应用TXA;B组:在A组基础上联合应用EPO及铁剂;C组:在B组基础上多次静脉应用TXA。搜集并比较3组总失血量、术后血红蛋白下降最大值、输血率、住院时间以及血栓发生情况。结果总失血量:(636.95±285.03)ml,明显低于A组(932.64±351.00)ml,B组(824.18±385.09)ml,(P<0.001)。术后血红蛋白下降最大值:C组(20.62±9.83)g/L,低于A组(28.91±15.02)g/L,B组(25.37±14.11)g/L,(P<0.001)。输血率:A组2.96%,B组2.40%,C组0.45%,三组比较呈下降趋势,但其差异无统计学意义(P=0.097)。住院时间:C组(9.92±3.17)天,低于A组(12.00±3.87)天,B组(11.57±3.84)天,差异有统计学意义(P<0.001)。术后发生肌间静脉血栓:A组61例,B组45例,C组18例,差异无统计学意义(P=0.956)。术后发生深静脉血栓:A组11例,B组9例,C组2例,差异无统计学意义(P=0.801)。整个住院及随访期间没有发生肺栓塞事件。结论 (1)应用EPO联合铁剂可有效降低TKA围手术期失血量,减少患者血红蛋白的丢失;(2)静脉多次应用TXA,能有效减少围手术期失血,改善术后贫血状况,缩短住院时间,且不增加血栓并发症的风险。Objective To evaluate clinical effects of the use of erythropoietin （ EPO ） and iron, combined with multiple-dose perioperative tranexamic acid in an enhanced recovery after surgery （ ERAS ） program for primary total knee arthroplasty （ TKA ）. Methods A large, single-center, retrospective study was conducted in 1540 patients who underwent primary TKA from May 2014 to January 2017. Study samples were divided into 3 groups. Group A received a single dose of IV-TXA combined with topical application of TXA. Group B received erythropoietin and iron supplement on the basis of Group A. Group C received multiple-dose IV-TXA regimen on the basis of Group B. Total blood loss （ TBL ）, maximum hemoglobin （ Hb ） drop, transfusion rate, length of hospital stay （ LOS ） and the incidence of thrombotic events were recorded and compared. Results The TBL and maximum Hb drop in Group C （ 636.95 ± 285.03 ） ml, （ 20.62 ± 9.83 ） g / L were significantly lower than those in Group B （ 824.18 ± 385.09 ） ml, （ 25.37 ± 14.11 ） g / L and Group A （ 932.64 ± 351.00 ） ml, （ 28.91 ± 15.02 ） g / L （ P 〈 0.001 ）. The TBL and maximum Hb drop in Group B were also lower than those in Group A （ P 〈 0.001 ）. The transfusion rate were 2.96%, 2.40% and 0.45% in Groups A, B, and C, which showed a downward tendency, however, the differences were not statistically significant （ P = 0.097 ）. LOS in Group C （ 9.92 ± 3.17 ） days was shorter than Group B （ 11.57 ± 3.84 ） days and A （ 12.00 ± 3.87 ） days （ P 〈 0.001 ）. The intramuscular venous thrombosis frequencies were 61, 45 and 18 in Group A, B, and C, and the differences were not statistically significant （ P = 0.956 ）. Eleven patients in Group A, 9 in Group B, 2 in Group C developed deep venous thrombosis and the differences did not reach statistical significance （ P = 0.801 ）. Furthermore, no episodes of pulmonary embolism occurred in all cases. Conclusions Application of EPO and iron could effectively reduc

关 键 词：关节成形术 置换 膝 氨甲环酸 输血 失血 手术 血液管理 加速康复外科 

分 类 号：R687.4[医药卫生—骨科学] R619[医药卫生—外科学]