全膝关节置换术后多次静脉应用氨甲环酸的有效性及安全性  

Efficacy and safety of multiple intravenously tranexamic acid in total knee arthroplasty: a retrospective trial

作　　者：许宏 张少云[1] 雷一霆 曹国瑞[1] 谢锦伟[1] 黄强[1] 裴福兴[1] XU Hong;ZHANG Shao-yun;LEI Yi-ting;et al(Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, China.)

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国矫形外科杂志》2018年第7期604-609,共6页Orthopedic Journal of China

基　　金：卫生部2013年度卫生行业科研专项项目(编号:201302007)

摘　　要：[目的]探讨初次单侧全膝关节置换术后多次静脉应用氨甲环酸抑制纤溶及减少失血的有效性及安全性。[方法]回顾性收集2015年7月～2017年3月在本中心行初次单侧全膝关节置换术患者的临床资料,根据术后氨甲环酸的使用方案将其分为A组(129例,术前5～10 min静脉给予20 mg/kg,3、6 h后各再次静脉给予1g)及B组(110例,术前5～10 min静脉给予20 mg/kg,3h、6h、9h及12h后各再次静脉给予1g)。记录并比较两组患者的总失血量、术后血红蛋白下降最大值、输血率、术后住院时间、纤溶水平、静脉血栓栓塞症、术后伤口及其他并发症的发生情况。[结果]共纳入符合条件的患者239例,B组患者总失血量及术后住院时间均小于A组[(559.07±306.77)ml vs(678.53±386.92)ml,P=0.010;(3.45±0.82)d vs(4.03±1.26)d,P<0.001)];B组患者术后24 h的纤维蛋白(原)降解产物及D-二聚体水平明显低于A组[(9.53±6.67)mg/L vs(17.41±16.59)mg/L,P<0.001;(4.22±3.43)mg/L vs(6.40±5.38)mg/L,P<0.001],而术后72 h两者差异无统计学意义(P>0.05);两组患者术后静脉血栓栓塞症、术后伤口及其他并发症的发生率差异无统计学意义(P>0.05)。[结论]初次单侧全膝关节置换术后多次静脉应用氨甲环酸可以进一步抑制纤溶反应,减少失血,缩短术后住院时间,且不会增加静脉血栓栓塞症的风险。[Objective] To assess the efficacy and safety of multiple intravenous tranexamic acid （TXA） on anti-fibrinolysis and blood loss in total knee arthroplasty （TKA） . [Methods] ] A retrospective study was conducted on 239 patients who underwent primary unilateral TKA from July 2015 to March 2017. Of them, 129 patients received a bolus intravenous injection of 20 mg/kg TKA before skin incision, and another 2 boluses of lg intravenously TXA 3 and 6 hours later （the group A）, whereas the remaining 110 patients had a bolus of 20 mg/kg before skin incision and another 4 boluses of lg TXA 3, 6, 9 and 12 hours later （the group B） . Total blood loss, maximum haemoglobin drop, transfusion rate, hospital stay, fibrinolysis parameters, venous thromboembolism and complications were compared between the two groups. [Results] The total blood loss in the group B was significantly less than that in the group A [（559.07±306.77）ml versus （678.53±386.92）ml, P〈0.05], similarly, the hospital stay in the group B was also considerably shorter than the group A [（3.45±0.82）d versus （4.03±1.26） d, P〈0.001] . In addition, the FDP [（9.53±6.67） mg/L versus （17.41±16.59） mg/L, P〈0.001] and D-dimer [（4.22±3.43） mg/L vs （6.40±5.38） mg/L, P〈0.001] in the group B proved statistically lower than those in group A at 24h postoperatively, although the statistical differences in FDP and D-dimer between two groups disappeared at 72h postoperatively （P〉0.05） .However, no significant difference was noted beduce blood loss and shorten hospital stay without increasing the risk of venous thromboembolism.

关 键 词：氨甲环酸 全膝关节置换术 静脉血栓栓塞症 抗纤溶 并发症 

分 类 号：R687.4[医药卫生—骨科学]