氨甲环酸于合并致静脉血栓栓塞事件形成高危并存疾病全膝置换的安全性和有效性  

Safety and effectiveness of tranexamic acid in patients combined with high risk comorbidities for postoperative venous thromboembolism during total knee arthroplasty

作　　者：邹春雨 岳辰 杨澜波 米豫飞 王战朝 ZOU Chun-yu;YUE Chen;YANG Lan-bo;MI Yu-fei;WANG Zhan-chao(Treatment Center of the Knee,Luoyang Orthopedic Hospital of Henan Province,Orthopedic Hospital of Henan Province,Luoyang,Henan 471000,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)膝部疾病研究治疗中心,河南洛阳471000

出　　处：《中华全科医学》2021年第6期901-903,共3页Chinese Journal of General Practice

基　　金：国家自然科学基金(81804126)。

摘　　要：目的评价氨甲环酸(tranexamic acid, TXA)于合并致静脉血栓栓塞事件(venous thromboembolism, VTE)形成高危并存疾病全膝关节置换(total knee arthroplasty, TKA)患者中应用的安全性和有效性。方法设定致TKA术后VTE形成风险增加的8个术前并存疾病,据此回顾河南省洛阳正骨医院2010年1月—2019年12月收治的初次单侧TKA患者资料,并根据氨甲环酸使用方法分为对照组、静脉TXA组、局部TXA组。安全性指标为VTE发生率,有效性指标为输血率。结果共回顾7 836例TKA,其中合并致VTE形成高危并存疾病的共781例。对照组341例,静脉TXA组163例,局部TXA组277例。对照组29例(8.50%)、静脉组16例(9.82%)、局部组22例(7.94%)发生术后VTE,组间比较差异无统计学意义。静脉TXA组(18.40%)及局部TXA组(22.38%)输血率明显较对照组(31.67%)低,差异有统计学意义(P=0.002)。结论静脉及局部TXA均不增加合并致VTE高危并存疾病TKA患者围术期VTE发生风险,且能有效降低输血率,TXA于此类TKA患者中应用安全有效。Objective To assess the safety and efficacy of tranexamic acid(TXA) in patients with high risk comorbidities for venous thromboembolic events(VTE) during total knee arthroplasty(TKA). Methods We chose eight risk factors for postoperative VTE during TKA. Patients in Luoyang Orthopedic Hospital of Henan Province were reviewed from January 2010 to December 2019 and were divided into control, intravenous TXA, and topical TXA group. The safety outcomes were identified as the incidence of VTE, and the efficacy outcome was limited to transfusions. Results Through a comprehensive review of 7 836 consecutive TKA cases from 2010 to 2019, 781 cases were included according to the inclusion criteria. Of them, 341 cases didn’t receive TXA, 163 patients received intravenous TXA and 277 patients received topical TXA. The incidence of VTE was not significant difference across these three groups(8.50% vs. 9.82% vs. 7.94%), and the transfusion rate was significantly lower in the intravenous and topical TXA groups than the control group(31.67% vs. 18.40% vs. 22.38%, P=0.002). Conclusion This study preliminary showed that TXA was effective to decrease transfusions without sacrificing the safety in patients with high risk comorbidities for VTE during TKA.

关 键 词：氨甲环酸 并存疾病 静脉血栓栓塞事件 全膝关节置换术 

分 类 号：R687.4[医药卫生—骨科学] R973.1[医药卫生—外科学]