氨甲环酸联合术中控制性降压减少初次全髋关节置换术围术期失血的临床研究  

Effectiveness and safety of tranexamic acid combined with intraoperative controlled hypotension on reducing perioperative blood loss in primary total hip arthroplasty

作　　者：张卿义 尹诗九 黄锴 王觅也 解慧琪[1,2] 廖刃[4] 曾羿[1,2] 杨静[1] ZHANG Qingyi;YIN Shijiu;HUANG Kai;WANG Miye;XIE Huiqi;LIAO Ren;ZENG Yi;YANG Jing(Department of Orthopedics,National Clinical Research Center for Geriatrics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China;Laboratory of Stem Cell and Tissue Engineering,Orthopedic Research Institute,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China;Information Center of West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China;Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)

机构地区：[1]四川大学华西医院骨科国家老年疾病临床医学研究中心,成都610041 [2]四川大学华西医院骨科研究所干细胞与组织工程研究室,成都610041 [3]四川大学华西医院信息中心,成都610041 [4]四川大学华西医院麻醉科,成都610041

出　　处：《中国修复重建外科杂志》2021年第9期1133-1140,共8页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家老年疾病临床医学研究中心重点项目(四川大学华西医院)(Z20191008);成都市科学技术局国际科技合作项目(2019-GH02-00076-HZ)。

摘　　要：目的评价氨甲环酸(tranexamic acid,TXA)联合术中控制性降压(intraoperative controlled hypotension,ICH)减少初次全髋关节置换术(total hip arthroplasty,THA)围术期失血的安全性与有效性。方法回顾分析2017年1月—2020年7月832例因股骨头坏死行初次THA患者的临床资料,所有患者均接受TXA治疗,其中439例(降压组)术中联合ICH将术中平均动脉压(mean arterial blood,MAP)控制在80 mm Hg(1 mm Hg=0.133 kPa)以下,393例(常压组)术中血压不进行特殊干预。两组患者年龄、性别、身体质量指数、美国麻醉师协会(ASA)分级、基础动脉压、髋关节活动度、合并内科疾病、术前血红蛋白(hemoglobin,Hb)及红细胞压积(hematocrit,HCT)水平、凝血功能、手术入路、TXA用量等一般资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者围术期失血及输血情况、麻醉及手术时间、住院时间、术后关节活动度及并发症情况。并进一步将纳入患者分为MAP<70 mm Hg组(A组)、MAP 70~80 mm Hg组(B组)和常压组(C组)3组,对围术期失血及术后并发症发生情况进一步行亚组分析,以筛选最佳血压范围。结果降压组术中MAP、总失血量、显性失血量、隐性失血量、输血率及输血量、麻醉时间、手术时间和住院时间均低于常压组(P<0.05)。降压组术后髋关节屈曲活动度优于常压组(Z=2.743,P=0.006),但两组外展活动度比较差异无统计学意义(Z=0.338,P=0.735)。术后并发症方面,降压组患者术后低血压发生率高于常压组(χ^(2)=6.096,P=0.014),其余并发症发生率比较差异无统计学意义(P>0.05)。两组均无脑卒中、肺动脉栓塞及下肢深静脉血栓形成发生,住院期间无死亡患者。亚组分析提示A、B组围术期总失血量、显性失血量及隐性失血量比较差异均无统计学意义(P>0.05),均显著低于C组(P<0.05);3组间输血率、输血量及急性心肌损伤发生率差异均无统计学意义(P>0.05);A组急性�Objective To evaluate the effectiveness and safety of tranexamic acid(TXA)combined with intraoperative controlled hypotension(ICH)for reducing perioperative blood loss in primary total hip arthroplasty(THA).Methods The clinical data of 832 patients with initial THA due to osteonecrosis of femoral head between January 2017 and July 2020 were retrospectively analyzed.All patients received TXA treatment,and 439 patients(hypotension group)received ICH treatment with an intraoperative mean arterial pressure(MAP)below 80 mm Hg(1 mm Hg=0.133 kPa)while 393 patients(normotension group)received standard general anesthesia with no special invention on blood pressure.There was no significant difference in age,gender,body mass index,American Society of Anesthesiologists(ASA)classification,basic arterial pressure,hip range of motion,internal diseases,preoperative hemoglobin(HB)and hematocrit(HCT),coagulation function,surgical approach,and TXA dosage between the two groups(P>0.05).The perioperative blood loss and blood transfusion,anesthesia and operation time,hospitalization stay,postoperative range of motion,and complications were recorded and compared between the two groups.The patients were further divided into MAP<70 mm Hg group(group A),MAP 70-80 mm Hg group(group B),and normotension group(group C).The perioperative blood loss and postoperative complications were further analyzed to screen the best range of blood pressure.Results The intraoperative MAP,total blood loss,dominant blood loss,recessive blood loss,blood transfusion rate and blood transfusion volume,anesthesia time,operation time,and hospitalizarion stay in the hypotension group were significantly lower than those in the normotension group(P<0.05).The postoperative hip flexion range of motion in the hypotension group was significantly better than that of the normotension group(Z=2.743,P=0.006),but there was no significant difference in the abduction range of motion between the two groups(Z=0.338,P=0.735).In terms of postoperative complications,the incidence of

关 键 词：氨甲环酸 控制性降压 围术期失血 输血 全髋关节置换术 

分 类 号：R687.4[医药卫生—骨科学]