氨甲环酸两种用药途径减少单侧全膝关节置换后出血的比较  

Intravenous versus articular injection of tranexamic acid for reducing hemorrhage after unilateral total knee arthroplasty

作　　者：陈冠宏[1] 秦磊[1] 黄辉[2] 王展[2] 马佳超 许营 翟喜成[1] Chen Guan-hong;Qin Lei;Huang Hui;Wang Zhan;Ma Jia-chao;Xu Ying;Zhai Xi-cheng(Shanxian Central Hospital,Shanxian 274300,Shandong Province,China;the Affiliated Hospital of Qingdao University,Qingdao 266000,Shandong Province,China)

机构地区：[1]单县中心医院,山东省单县274300 [2]青岛大学附属医院,山东省青岛市266000

出　　处：《中国组织工程研究》2018年第3期350-355,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:膝关节围手术期失血一直是困扰关节外科医生的常见问题,氨甲环酸减少术后出血的作用日益受到重视,但对于选用何种用药途径仍存在争议。目的:探讨氨甲环酸静脉给药及关节腔注射两种给药途径对降低全膝关节置换术中、术后失血量的影响。方法:选择60例拟行初次单侧全膝关节置换的患者,以分层随机分组法分成3组:A组(n=20):不应用氨甲环酸;B组(n=20):应用止血带前缓慢静滴15 mg/kg氨甲环酸,术后3 h再给予10 mg/kg氨甲环酸;C组(n=20):封闭关节腔后经引流管注入稀释在50 m L生理盐水中的1 g氨甲环酸。3组均在术后夹闭引流管2 h。记录各组置换后显性失血量、隐性失血量、输血率,同时观察是否有肺栓塞及下肢深静脉血栓发生。结果与结论:(1)B、C组患者同A组相比,显性失血量和隐性失血量均明显减少,差异有显著性意义(P<0.05);B组与C组在显性失血量方面差异无显著性意义(P>0.05),在隐性失血量方面B组显著小于C组(P<0.05);(2)B组及C组患者输血人数明显小于A组,差异有显著性意义(P<0.05);(3)3组患者置换后3个月随访未发现下肢深静脉血栓形成、肺栓塞的发生;(4)结果表明,氨甲环酸能明显减少初次单侧全膝关节置换的围手术期失血量及输血率,不增加下肢深静脉血栓形成、肺栓塞的风险,且静脉给药效果更好。BACKGROUND:The perioperative hemorrhage of knee surgeries is a difficulty in clinic,and the efficacy of tranexamic acid to reduce postoperative bleeding has attracted more attention,but choosing which administrations remains controversial.OBJECTIVE:To investigate the efficacy of tranexamic acid by intravenous injection or articular injection for reducing the perioperative hemorrhage of total knee arthroplasty.METHODS:Sixty patients undergoing unilateral total knee replacement were enrolled,and were then randomized into three groups(n=20 per group):no tranexamic acid administration(group A);intravenous dropping of 15 mg/kg tranexamic acid before tourniquet application plus 10 mg/kg tranexamic acid at 3 hours postoperatively(group B);articular injection of 50 mL saline diluted with 1 g tranexamic acid through a drainage tube(group C).Two-hour closure of drainage tube was performed in all patients.The postoperative dominant and hidden blood loss,blood transfusion rate,pulmonary embolism as well as lower extremity deep venous thrombosis were recorded.RESULTS AND CONCLUSION:(1)The dominant and hidden blood loss in the groups B and C were significantly less than those in the group A(P<0.05);the dominant blood loss showed no significant difference between groups B and C(P>0.05);the group B exhibited a significantly less hidden blood loss compared with group C(P<0.05).(2)The blood transfusion rate in the groups B and C was significantly lower than that in the group A(P<0.05).(3)No pulmonary embolism or lower extremity deep venous embolism occurred during 3-month follow-up.(4)That is to say,tranexamic acid can obviously reduce perioperative blood loss and blood transfusion rate without pulmonary embolism or lower extremity deep venous thrombosis,and intravenous administration exerts better clinical effectiveness.

关 键 词：关节成形术 置换 膝 氨甲环酸 假体植入 出血 组织工程 

分 类 号：R318[医药卫生—生物医学工程]