氨甲环酸对膝关节保肢术围手术期出血影响的研究  

Effectiveness of tranexamic acid in reducing bleeding in limb salvage around knee joints

作　　者：严晓波[1] 蔡伟康 林秾[1] 叶招明[1] 黄鑫[1] 潘伟波[1] 柳萌[1] Yan Xiaobo;Cai Weikang;Lin Nong;Ye Zhaoming;Huang Xin;Pan Weibo;Liu Meng(Department of Orthopaedic,The Second Affiliated Hospital of Zhejiang University,Zhejiang 310009,China;Department of Orthopaedic,Yongkang Hospital of TCM,Yongkang 321300,China)

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009 [2]浙江省永康市中医院骨科,永康321300

出　　处：《中华骨科杂志》2020年第15期1004-1010,共7页Chinese Journal of Orthopaedics

摘　　要：目的:评估术前静脉内滴注氨甲环酸联合术中切口内局部浸润氨甲环酸对降低膝关节周围肿瘤大段切除后假体置换手术围手术期出血量的有效性和安全性。方法:回顾性分析2014年12月至2018年11月共116例在我院治疗的膝关节周围肿瘤进行肿瘤大段切除人工关节置换手术患者,根据是否在术前静脉内滴注氨甲环酸联合术中切口内局部浸润氨甲环酸分为氨甲环酸组(26例)和无氨甲环酸组(90例)。统计分析两组患者的术后引流量、总失血量、是否输血、术后第3 d的血红蛋白、纤维蛋白原水平,药物相关副反应、伤口并发症。对计量资料采用独立样本t检验比较差异;计数资料组间比较采用χ^2检验。结果:90例无氨甲环酸组中39例需行术前化疗,26例氨甲环酸组中8例。氨甲环酸组中股骨远端23例(88.46%),胫骨近端3例(11.54%);无氨甲环酸组中股骨远端59例(65.56%),胫骨近端31例(34.44%)。氨甲环酸组截骨长度为(15.21±4.69)cm,无氨甲环酸组为(14.01±3.26)cm,两组基本相近。氨甲环酸组手术时间2.34 h,无氨甲环酸组用时2.57 h;氨甲环酸组术中出血量为(440.39±208.48)ml,无氨甲环酸组为(613.33±212.76)ml,差异有统计学意义(t=3.636,P=0.002)。氨甲环酸组输血15例(57.69%),无氨甲环酸组54例(60%),差异有统计学意义(χ^2=4.771,P=0.029)。氨甲环酸组总引流量(468.08±220.74)ml,无氨甲环酸组(623.92±316.87)ml,差异有统计学意义(t=2.328,P=0.022);氨甲环酸组估算总失血量为(236.75±116.56)ml,无氨甲环酸组为(440.47±194.23)ml,差异有统计学意义(t=5.046,P=0.000);术后第3天血红蛋白:氨甲环酸组(92.12±13.66)g/L,无氨甲环酸组(84.29±11.21)g/L,差异有统计学意义(t=-2.951,P=0.004);围手术期失血量:氨甲环酸组为(586.75±409.93)ml,无氨甲环酸组为(866.14±418.68)ml,差异有统计学意义(t=2.985,P=0.003)。所有患者术后3 d复查凝血功能,氨甲环酸组患者术后3 d时凝血酶原�Objective To evaluate the effectiveness and safety of intravenous infusion of tranexamic acid combined with local infiltration in reducing the perioperative bleeding of prosthetic replacement surgery after massive tumor resection around the knee joint.Methods Retrospective analysethe patients treated in our hospital from December 2014 to November 2018 underwent tumor resection and prothesis replacement surgery for tumors around the knee,according to whether intravenous infusion of tranexamic acid combined local infiltration of tranexamic acid in the incision was divided into tranexamic acid group and control group.Statistical analysis of postoperative drainage volume,total blood loss,number of blood transfusion,hemoglobin and fibrinogen level in 3 days after surgery,drug-related side effects,wound complications.The differences between the measurement data of the two groups used independent sample t test to compare;the comparison between the count data groups was byχ^2 test.Results In all 116 patients,preoperative intravenous infusion of tranexamic acid combined with intraoperative local infiltration of tranexamic acid in 26 patients,90 cases in control group;39 of the replacement required preoperative chemotherapy,There were 8 cases in the tranexamic acid group.In the tranexamic acid group,there were 23 cases(88.46%)in the distal femur and 3 cases(11.54%)in the proximal tibia,and 59 cases(65.56%)in the proximal femur in control group,and 31 cases(34.44%)of the proximal tibia.The length of the osteotomy is similar,the control group is 14.01±3.26 cm,and the tranexamic acid group is 15.21±4.69 cm.The operation time in control group was 2.57 h,and the tranexamic acid group was 2.34 h.Bleeding volume:the bleeding in control group was 613.33±212.76 ml,and the tranexamic acid group was 440.39±208.48 ml(t=3.636,P=0.002).There were 54 patients(60%)had blood transfusion in control group,and 15 patients(57.69%)in the tranexamic acid group.There was a significant difference between two groups(χ^2=4.771,P=0.029).The tot

关 键 词：膝关节 肿瘤 氨甲环酸 失血 手术 

分 类 号：R687.4[医药卫生—骨科学]