氨甲环酸不同二联用药方式对全膝关节置换手术失血的影响  

Effect of different bigeminal methods of tranexamic acid on blood loss after total knee arthroplasty

作　　者：刘金磊 殷力[1] 张翼[1] 王海涛[1] 李庄严 夏培格 乔仁秋 Liu Jinlei;Yin Li;Zhang Yi;Wang Haitao;Li Zhuangyan;Xia Peige;Qiao Renqiu(Department of orthopedics,The First Afiliated Hospital of Zhengzhou University,Zhengzhou,450000,China)

机构地区：[1]郑州大学第一附属医院骨科一病区,郑州450000

出　　处：《河南外科学杂志》2020年第6期34-37,共4页Henan Journal of Surgery

摘　　要：目的 探讨氨甲环酸(TXA)不同二联用药方式对全膝关节置换术(TKA)失血的影响.方法 前瞻性纳入2018-12—2019-11间郑大一附院骨科一病区行单侧TKA的患者,根据TXA不同二联用药方式分为装假体前静滴联合关节腔多点注射TXA组(联合注射组),装假体前静滴联合关节腔灌注TXA组(联合灌注组),装假体前静滴联合术后3 h静滴TXA组(联合静滴组),比较3组患者的基线资料和手术总失血量、引流量、隐性失血量、最大血红蛋白下降值、输血率、输血量,以及下肢深静脉血栓形成(DVT)、肺栓塞(PE)等并发症发生情况.结果 共纳入90例患者,每组30例.3组患者的基线资料差异无统计学意义(P>0.05).联合灌注组的总失血量、引流量、最大血红蛋白下降值明显低于联合注射组、联合静滴组,差异有统计学意义(P<0.05);联合灌注组、联合静滴组间的隐性失血量差异无统计学意义(P>0.05),但均小于联合注射组,差异有统计学意义(P<0.05).3组的输血率和输血量差异无统计学意义(P>0.05),且均未发生DVT、PE等并发症.结论 TKA术中TXA静滴联合关节腔灌注,可有效减少手术总失血量、引流量、隐性失血量,以及最大血红蛋白下降值,且不增加DVT、PE等并发症发生率.Objective To study the effect of different bigeminal methods of tranexamic acid(TXA)on blood loss after total knee arthroplasty(TKA).Methods From 2018-12 to 2019-11, 90 patients who underwent unilateral total knee arthroplasty were selected from the Department of Orthopedics of the First Affiliated Hospital of Zheng University. According to the envelope method, they were randomly divided into group A(intravenous drip of TXA before the implantation of prosthesis combined with joint cavity multi-point injection of TXA), group B(intravenous drip of TXA before the implantation of prosthesis combined with joint cavity perfusion of TXA)and group C(intravenous drip of TXA before the implantation of prosthesis and 3 h after operation).Observe the general information of the 3 groups patients, the total blood loss, drainage volume, hidden blood loss, maximum hemoglobin decline, blood transfusion rate and the volume of blood transfusion, the incidence of deep vein thrombosis(DVT)of the lower limbs and other adverse events.Results There was no statistically significant difference in general information between the 3 groups(P>0.05).The total blood loss, drainage volume, and maximum hemoglobin decline in group B were significantly lower than those of groups A and C, and the difference was statistically significant(P<0.05).The difference in hidden blood loss between group B and C was not statistically significant(P<0.05), but both were smaller than that of group A, and the difference was statistically significant(P<0.05).There was no significant difference in blood transfusion rate and blood transfusion volume between the three groups(P>0.05), and there were no DVT and other adverse events in the three groups.Conclusion Intravenous TXA combined with articular cavity perfusion of TXA during TKA can effectively reduce postoperative total blood loss, drainage volume, hidden blood loss and maximum hemoglobin decline, without increasing the incidence of DVT and other adverse events.

关 键 词：全膝关节置换术 氨甲环酸 局部多点注射 局部灌注 失血量 

分 类 号：R687.4[医药卫生—骨科学]