全髋置换术使用氨甲环酸安全及有效性的临床研究  

Clinical Study on the Safety and Effectiveness of Tranexamic Acid in Total Hip Replacement Surgery

作　　者：王高 张敏[1] 林开宇 李斌华 胡中立 张强 WANG Gao;ZHANG Min;LIN Kaiyu;LI Binhua;HU Zhongli;ZHANG Qiang(Nanchang Hongdu Hospital of Traditional Chinese Medicine,Affiliated to Jiangxi University of Traditional Chinese Medicine,Nanchang Jiangxi 330006,China)

机构地区：[1]江西中医药大学附属南昌市洪都中医院,江西南昌330006

出　　处：《药品评价》2021年第20期1260-1262,共3页Drug Evaluation

基　　金：江西省卫生健康委科技计划(202140164)。

摘　　要：目的:探讨全髋置换术(THA)使用氨甲环酸(TXA)安全性及有效性。方法:选取2018年8月至2020年9月在江西中医药大学附属南昌市洪都中医院行THA术治疗的125例股骨颈骨折患者,按治疗方式不同分为对照组(25例)和试验组(100例)。试验组术中使用TXA治疗,试验1组:切皮前0.5 h,在0.9%氯化钠注射液(NS)100 mL中加入TXA 10 mg/kg行静脉滴注;试验2组:关闭切口前,在NS 100 mL中加入TXA 2 g,注射入关节腔内;试验3组:缝合前,在NS 100 mL中加入TXA 2 g,注射于关节囊周围;试验4组:切口关闭后,在NS 100 mL中加入TXA 2 g,由引流管注入。对照组不使用TXA等相关药物。比较两组围术期指标、关节功能恢复情况、不良反应。结果:试验组术中失血量、隐性出血量、术后引流量均低于对照组,试验1组各指标<试验2组<试验3组<试验4组,差异有统计学意义(P<0.05);试验组术后Harris评分均高于对照组,且试验1组>试验2组>试验3组>试验4组,差异有统计学意义(P<0.05);各组治疗期间均无明显不良反应发生。结论:THA用TXA治疗安全性较高,能减少围术期出血量,改善髋关节功能,切皮前0.5 h静脉滴注TXA10 mg/kg效果最佳。Objective:To investigate the safety and effectiveness of tranexamic acid(TXA)in total hip replacement(THA).Methods:A total of 125 patients with femoral neck fractures who underwent THA surgery in Nanchang Hongdu Hospital of Traditional Chinese Medicine from August 2018 to September 2020 were selected and divided into a control group(25 cases)and an experimental group(100 cases)according to different treatment methods.The experimental group was treated with TXA intraoperatively.Experimental group 1:0.5 h before skin incision,added TXA 10 mg/kg to 0.9%sodium chloride injection(NS)100 mL for intravenous drip;experimental group 2:before closing the incision,in NS TXA 2 g was added to 100 mL and injected into the joint cavity;experiment group 3:before suture,TXA 2 g was added to NS 100 mL and injected around the joint capsule;experiment group 4:after the incision was closed,TXA 2 g was added to NS 100 mL,by drainage tube was injected.The control group did not use TXA and other related drugs.The perioperative indexes,joint function recovery and adverse reactions were compared between the two groups.Results:The blood loss,occult blood loss,and postoperative drainage volume of the experimental group were lower than those of the control group.The indexes of the experimental group 1 were lower than the experimental group 2<the experimental group 3<the experimental group 4.The difference was statistically significant(P<0.05);the Harris scores of the experimental group were higher than those of the control group after surgery,and experimental group 1>experiment 2>experiment 3>experiment 4.There was a statistical difference(P<0.05);no significant adverse reactions occurred during treatment in each group.Conclusion:TXA treatment for THA is safer,can reduce perioperative bleeding and improve hip joint function.TXA 10 mg/kg intravenous infusion 0.5 h before skin incision has the best effect.

关 键 词：失血 手术 股骨颈骨折 全髋关节置换 术中失血 氨甲环酸 

分 类 号：R687.4[医药卫生—骨科学]