氨甲环酸在初次膝关节置换中的应用研究  

Application of ammoniacal acid in primary total knee arthroplasty

作　　者：白伟侠 牛映祯 马红瑞 卢连君[1] 何丽英[1] 秦迪[1] 王飞[1] Bai Weixia;Niu Yingzhen;Ma Hongrui;Lu Lianjun;He Liying;Qin Di;Wang Fei(Department of Joint, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China;Department of Anesthesiology, Hospital of Xinle, Xinle 050700, China)

机构地区：[1]河北医科大学第三医院关节外科,石家庄050051 [2]河北省新乐市医院麻醉科,050700

出　　处：《中华老年骨科与康复电子杂志》2017年第6期362-366,共5页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：卫生部医药卫生科技项目(13010520140799)

摘　　要：目的评估两种不同氨甲环酸给药方式在初次膝关节置换中的应用效果。方法前瞻性收集2014年1月至2015年12月河北医科大学第三医院关节科收治的初次膝关节置换术患者98例,采用随机数字表法将其分为两组,实验组患者(49例)于切皮前0.5 h静脉滴注15 mg/kg氨甲环酸,术中关节腔注射1 mg氨甲环酸,术后3 h滴注10 mg/kg氨甲环酸。对照组患者(49例)于切皮前静脉滴注15 mg/kg氨甲环酸,术中关节腔注射1 mg氨甲环酸患者。分别于术后24 h评估两组患者的出血量、输血量以及血红蛋白、血细胞容积变化情况。结果 98例患者均获得完整随访,随访时间(10±3)d。术后实验组出血量(176±34 ml)低于对照组(212±40 ml,t=2.972,P<0.05)。实验组术后血红蛋白含量(109±10 g/L)高于对照组(107±8 g/L,t=2.681,P<0.05)。实验组的住院天数(6.0±2.2 d)低于对照组(8.4±3.0 d,t=2.641,P<0.05)。结论初次膝关节置换术后静脉重复给药联合关节腔内注射氨甲环酸可减少出血量,缩短住院时间。Objective To evaluate the effect of different ways of tranexamic acid(TXA)on primary total knee arthroplasty(TKA).Methods A prospective study was performed in98patients of TKA treated in the Joint department of the third Hospital of Hebei Medical University from January2014to December2015,patients were divided into two groups randomly.The treatment group(n=49)was given15mg/kg TXA intravenous injection0.5h before incision,1.0g TXA intraarticular injection intraoperatively,10mg/kg TXA intravenous injection3hours post-operatively.The control group(n=49)was given15mg/kg TXA intravenous injection before incision,1.0g TXA intraarticular injection intraoperatively.The bleeding volume,transfusion volume as well as variation of hemoglobin and blood volume within24h after surgery were compared between two groups.Results All patients were followed-up with an average of10±3d.There was no deep venous thrombosis(DVT)among all patients after surgery.The blood loss of the experimental group(176±34ml)were significantly lower than the control group(212±40ml)after surgery(t=2.972,P<0.05).The hemoglobin content of the experimental group(109±10g/L)were significantly higher than the control group(107±8g/L)after surgery(t=2.681,P<0.05).The mean hospital stay of the experimental group(6.0±2.2d)were significantly higher than the control group(8.4±3.0d,t=2.641,P<0.05).Conclusions Postoperative bleeding volume and hospital stay was significantly decreased in primary TKA with reduplicative intravenous administration combined with intraarticular injection of TXA.

关 键 词：关节成形术 置换 膝 氨甲环酸 血栓形成 出血量 

分 类 号：R687.4[医药卫生—骨科学]