关节腔局部注射不同剂量氨甲环酸对单侧全膝关节置换术失血的影响  

Effect of intra-articular injection of different doses of Tranexamic Acid on postoperative blood loss of unilateral total knee arthroplasty

作　　者：王先锋 唐淼[1] 王岩岩 刘长征[1] WANG Xianfeng;TANG Miao;WANG Yanyan;LIU Changzheng(First Department of Orthopedics,Suzhou Municiple Hospital,Suzhou,Anhui 234000,China)

机构地区：[1]宿州市立医院骨一科,安徽宿州234000

出　　处：《安徽医药》2019年第6期1237-1240,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探究关节腔局部注射不同剂量氨甲环酸(TXA)对减少单侧全膝关节置换术(TKA)失血的影响。方法收集2013年1月至2016年12月在宿州市立医院行单侧TKA的病人120例,利用抛硬币法随机分为A、B、C、D四组,每组各30例,均于止血带释放前关节囊缝合后局部关节腔注射药剂,其中A组注射50 mL生理盐水,B组注射含有10 mg/kg的TXA生理盐水50 mL,C组注射20 mg/kg的TXA生理盐水50 mL,D组注射含有30 mg/kg的TXA生理盐水50 mL,统计四组病人术后总引流量,术前、术后24 h和72 h的血红蛋白(hemoglobin,Hb),输血率以及术后并发症的发生率,分析四组间差异。结果在术后引流量方面,D组[(343.53±68.60) mL]<C组[(404.57±62.59) mL]<B组[(452.57±71.72) mL]<A组[(532.67±87.05) mL],组间差异有统计学意义(F=35.847,P<0.05);在Hb水平方面,四组术前差异无统计学意义(F=0.137,P=0.938),而在术后24 h和72 h方面,D组(120.70±9.60、110.83±11.04) mL>C组(112.57±9.75、102.33±11.16) mL>B组(105.50±9.84、93.30±11.95) mL>A组(98.13±9.83、83.10±13.03) mL,组间差异有统计学意义(均P<0.05);输血率方面,D组(3.33%)最低,A组(36.67%)最高,差异有统计学意义(χ~2=11.779,P=0.008);并发症发生率方面,四组差异无统计学意义(χ~2=3.025,P=0.388)。结论关节腔注射TXA可以减少单侧TKA后病人的失血量和输血需求,不增加并发症的发生率,30 mg/kg为最佳剂量。Objective To investigate the effect of intra-articular injection of different doses of Tranexamic Acid(TXA)on decreased blood loss after unilateral total knee arthroplasty(TKA).Methods A hundred and twenty patients,who underwent unilateral TKA in Suzhou Municiple Hospital from January 2013 to December 2016,were collected and randomly assigned into groups A,B,C and D by coin flipping method,with 30 cases in each group.Intra-articular injection was performed before tourniquet release and after articular suture.Patients in group A were injected with 50 mL normal saline,patients in group B with 10 mg/kg TXA 50 mL normal saline,patients in group C with 20 mg/kg TXA 50 mL normal saline,and patients in group D with 30 mg/kg TXA 50 mL normal saline.The postoperative total suction drainage,preoperative and postoperative 24 h,72 h hemoglobin(Hb),the ratio of blood transfusion and the incidence rate of complications were recorded and compared among the four groups.Results In terms of the postoperative total suction drainage,group D[(343.53±68.60)mL]<group C[(404.57±62.59)mL]<group B[(452.57±71.72)mL]<group A[(532.67±87.05)mL],and the difference between the groups was statistically significant(F=35.847,P<0.05).In terms of preoperative Hb level,there was no statistically significant difference among the four groups(F=0.137,P=0.938),while in terms of the postoperative 24 h and 72 h Hb levels,group D[(120.70±9.60,110.83±11.04)mL]>group C[(112.57±9.75,102.33±11.16)mL]>group B[(105.50±9.84,93.30±11.95)mL]>group A[(98.13±9.83,83.10±13.03)mL],and the difference was statistically significant(all P<0.05).The transfusion rate was the lowest in group D(3.33%)and the highest in group A(36.67%),and the difference was statistically significant(χ^2=11.779,P=0.008).The ratio of complications among groups had no statistical difference(χ^2=3.025,P=0.388).Conclusion Intra-articular injection of TXA in unilateral TKA can effectively reduce the blood loss and blood transfusion rate of the patients and will not increase the risk of

关 键 词：全膝关节置换术 氨甲环酸 失血量 关节腔注射 

分 类 号：R687.4[医药卫生—骨科学]