氨甲环酸减少初次全髋关节置换术失血量的疗效研究  

Efficacy of tranexamic acid in the reduction of perioperative blood loss during primary total hip arthroplasty

作　　者：施耀华[1] 张曦[1] 伏治国[1] 

机构地区：[1]江苏省常州市中医医院骨科,213003

出　　处：《国际骨科学杂志》2018年第1期59-62,共4页International Journal of Orthopaedics

摘　　要：目的探讨氨甲环酸(TXA)在初次全髋关节置换术中的应用剂量、效果及并发症发生情况。方法将常州市中医院2016年2月至2017年1月需行单侧初次全髋关节置换术的65例患者随机分为对照组(20例)、单次组(23例)、重复组(22例)。单次组于术前15 min静脉滴注TXA15 mg/kg,重复组除在术前15 min静脉滴注TXA15 mg/kg外,术后3 h静脉滴注TXA10 mg/kg。比较3组出血量、引流量、输血率、血栓相关事件发生情况。结果对照组、单次组和重复组术中出血量分别为(485.0±96.1)mL、(354.4±45.0)mL、(320.0±78.7)mL,对照组出血量大于单次组和重复组(P值均<0.001)。对照组、单次组和重复组术后引流量分别为(331.5±70.1)mL、(269.1±61.1)mL、(200.7±43.9)mL,对照组术后引流量大于单次组和重复组(分别为P=0.003和P<0.001),且单次组术后引流量多于重复组(P=0.001)。对照组、单次组和重复组分别有13例(65.0%)、8例(34.8%)、2例(9.1%)输血,对照组输血率高于单次组和重复组(分别为P=0.048和P<0.001),单次组输血率高于重复组(P=0.003 8)。3组血栓相关事件发生率无统计学差异(P>0.05)。结论静脉滴注TXA可有效减少初次全髋关节置换术中出血量和输血率,其中术后重复使用较术前单次使用效果更佳,且不增加血栓发生率。Objective To investigate the dose,clinical outcomes and complications of tranexamic acid(TXA)in primary total hip arthroplasty.Methods From February 2016 to January 2017,a total of 65 patients who had to undergo unilateral primary total hip arthroplasty were randomly divided into three groups:control group(20 cases),single-dose group(23 cases)and repeated-dose group(22 cases).Patients in the single-dose group received intravenous infusion of 15 mg/kg TXA at 15 min before surgery,while patients in the repeated-dose group received additional intravenous infusion of 10 mg/kg TXA at 3 h after surgery.The perioperative blood loss,postoperative drainage volume,the number of perioperative blood transfusion and incidence of deep vein thrombosis were recorded and compared among the three groups.Results The perioperative blood loss of the control group was significantly higher than that of the single-dose group(485.0±96.1 mL versus 354.4±45.0 mL,P<0.001)and the repeated-dose group(485.0±96.1 mL versus 320.0±78.7 mL,P<0.001).The postoperative drainage volume of the control group was significantly higher than that of the single-dose group(331.5±70.1 mL versus 269.1±61.1 mL,P=0.003)and the repeated-dose group(331.5±70.1 mL versus 200.7±43.9 mL,P<0.001);the postoperative drainage volume of the single-dose group was higher than that of the repeated-dose group(P=0.001).Thirteen patients in the control group(65.0%),8 patients in the single-dose group(34.8%)and 2 patients in the repeated-dose group(9.1%)received blood transfusion.The blood transfusion rate of the control group was significantly higher than that of the single-dose group(P=0.048)and the repeated-dose group(P<0.001);the blood transfusion rate of the single-dose group was significantly higher than that of the repeated-dose group(P=0.003 8).However,the postoperative incidence of deep vein thrombosis was not significantly different among the three groups(P>0.05).Conclusion Intravenous infusion of TXA could effectively reduce the perioperative blood loss and bloo

关 键 词：氨甲环酸 全髋关节置换 出血量 输血率 

分 类 号：R687.4[医药卫生—骨科学]