氨甲环酸给药时间与TKA围手术期失血量的临床研究  

Clinical Study of Intravenous Tranexamic Acid to Reduce Perioperative Blood Loss in Total Knee Arthroplasty at Different Dosage Time

作　　者：潘文杰[1] 贺艳[2] 马建兵[1] 肖琳[1] 姜扩 Pan Wenjie;He Yan;Ma Jianbing(Department of Bone and Joint Surgery,Xi＇an Hong Hui Hospital,Medical College,Xi＇an Jiaotong University,Xi＇an 710054;Department of Pharmacy,Xi＇an NO.4 Hospital,Xi＇an 710004)

机构地区：[1]西安交通大学医学院附属红会医院关节外科,陕西西安710054 [2]西安市第四医院药剂科,陕西西安710004

出　　处：《实用骨科杂志》2018年第9期786-789,共4页Journal of Practical Orthopaedics

基　　金：陕西省重点科技创新团队项目(2013KCT-26)

摘　　要：目的对比氨甲环酸不同的静脉给药时间减少全膝关节置换术围手术期的失血量和输血率的疗效。方法选取2017年1月至2017年12月行初次单侧全膝关节置换的168例患者,男45例,女123例;年龄60~77岁,平均70.5岁;诊断为骨关节炎。按照静脉给药时间随机分为A、B、C、D四组,每组42例。A、B、C组按20mg/kg计算的量稀释于250mL生理盐水中,分别于止血带充气前、松止血带前和松止血后20min静脉注射,D组仅给予等量生理盐水静脉注射。对比四组总失血量(术中和术后失血量)、输血量、输血率、术后血红蛋白减少量、相关凝血功能及术后静脉血栓形成风险的差异,于术后7d进行下肢血管多普勒检查。结果总失血量、血红蛋白减少量、输血量、输血率A组均明显少于B、C、D组(P<0.05),B、C组少于D组(P<0.05),B、C组之间比较差异无统计学意义(P>0.05)。四组纤维蛋白原、凝血酶原时间、活化的部分凝血活酶时间比较差异无统计学意义(P>0.05)。四组患者术后深静脉血栓发生率差异无统计学意义(P>0.05)。结论氨甲环酸能有效减少初次单侧TKA围手术期的失血量、血红蛋白下降和输血率;止血带充气前使用氨甲环酸更有优势。Objective To compare the clinical efficacy of intravenous tranexamic acid to reduce perioperative blood loss and transfusion rate in total knee arthroplasty at different dosage time.Methods From January 2017 to December2017,a total of 168 patients（45 males,123 females）who were planned to undergo primary unilateral TKA.The average age of the patients was 70.5 years old ranging from 60 to 77 years.The diagnoses of the patients were osteoarthritis.All the cases were randomly divided into groups A,B,C and D（42 cases in each group）according to dosage time of tranexamic acid intravenous administration.The patients in groups A,B,and C received tranexamic acid（20 mg/kg,tranexamic acid was dissolved in 250 mL of normal saline）20 mins before tourniquet inflation,before tourniquet deflation or after tourniquet deflation respectively.The patients in groups D received an equa1 volume of normal saline.Total blood loss（intraoperative and postoperative blood loss）,Hemoglobin losses,blood transfusion volume and blood transfusion rate of all patients were measured and analyzed.Fibrinogen（FIB）,prothrombin time（PT）and activated partial thromboplastin time（APTT）were also examined.And they were also observed for whether they had deep vein thrombosis（DVT）and both lower limbs of all patients were examined by the color Doppler uhrasonography 7 days after operation.Results Total blood loss,hemoglobin losses,blood transfusion volume and blood transfusion rate in group A was lower than those in group B,C,D（P〈0.05）,and in group B.C was lower than those in group D（P〈0.05）.However,such differences were not detected between groups B and C（P〈0.05）.There were no significant differences in the levels of fibrinogen,prothrombin time,and activated partial thromboplastin time between four groups（P〈0.05）,and no significant difference was detected in the incidence of venous thrombosis（P〉0.05）.Conclusion Tranexamic acid reduces perioperative blood loss,hemoglobin losses and transfusion rate in

关 键 词：关节成形术 置换 膝 氨甲环酸 静脉注射 失血 手术 

分 类 号：R687.42[医药卫生—骨科学]