膝关节置换术围手术期失血因素与氨甲环酸对隐性出血量的影响分析  

The analysis on perioperative blood loss factors and effect of tranexamic acid on the amount of occult bleeding in total knee arthroplasty

作　　者：平伟[1] 王伟[1] 宋巍 李盼红 刘小娟 Ping Wei;Wang Wei;Song Wei;Li Panhong;Liu Xiaojuan(Department of Orthopaedics,Dingzhou People′s Hospital,Hebei Dingzhou 073000,China)

机构地区：[1]河北省定州市人民医院骨科,073000

出　　处：《中国医师进修杂志》2021年第12期1128-1132,共5页Chinese Journal of Postgraduates of Medicine

基　　金：河北省2020年度医学科学研究课题计划项目(20200308)。

摘　　要：目的探讨膝关节置换术(TKA)围手术期失血因素,并分析氨甲环酸对隐性出血量的影响。方法选取2018年8月至2020年8月河北省定州市人民医院接受TKA手术治疗的100例患者作为研究对象,根据是否使用氨甲环酸分为氨甲环酸组(68例)和未使用氨甲环酸组(32例),并分析年龄、有无合并症、止血带使用时间、体质量指数(BMI)、血小板计数(PLT)水平及氨甲环酸使用对TKA围手术期隐性失血量的影响。结果单因素分析显示,年龄、有无合并症、止血带使用时间、BMI及PLT水平等因素对隐性失血有显著影响,不同组别差异有统计学意义(P<0.05),而性别、疾病类型、手术侧别、手术时间及输血类型等对隐性失血无显著影响(P>0.05);氨甲环酸组隐性出血量显著低于未使用氨甲环酸组[(662.47±65.82)ml比(733.86±59.86)ml](P<0.05);氨甲环酸组异体输血占比显著低于未使用氨甲环酸组[45.49%(31/68)比68.75%(22/32)](P<0.05);氨甲环酸组术后引流量、围手术期总失血量均显著低于未使用氨甲环酸组[(211.54±85.63)ml比(427.61±103.08)ml、(995.38±187.11)ml比(1276.42±236.84)ml](P<0.05);多因素分析显示,年龄、合并症、止血带使用时间、BMI是影响围手术期隐性失血量增加的独立危险因素(P<0.05),而氨甲环酸是保护因素(P<0.05)。结论高龄、有合并症、止血带使用时间过长、肥胖均会造成TKA围手术期隐性失血量增加,使用氨甲环酸则能有效减少其隐性失血。Objective To explore the factors of perioperative blood loss during total knee arthroplasty(TKA),and to analyze the influence of tranexamic acid on the amount of occult bleeding.Methods A total of 100 patients who underwent TKA surgery in the knee surgery department of Dingzhou People′s Hospital from August 2018 to August 2020 were selected as the research subjects.According to whether tranexamic acid was used or not,they were divided into tranexamic acid group(68 cases)and non-tranexamic acid group(32 cases).The influence of the age,presence or absence of comorbidities,tourniquet use time,body mass index(BMI),platelet count(PLT)levels,and tranexamic acid use on TKA perioperative occult blood loss were analyzed.Results Univariate analysis showed that factors such as age,presence or absence of comorbidities,tourniquet use time,BMI and PLT levels had a significant effect on occult blood loss,and the difference between different groups was statistically significant(P<0.05),while gender and disease type,operation side,operation time and blood transfusion type had no significant effect on occult blood loss(P>0.05);The latent blood loss in the tranexamic acid group was significantly lower than that in the non-tranexamic acid group:(662.47±65.82)ml vs.(733.86±59.86)ml,P<0.05.The proportion of allogeneic blood transfusion in the tranexamic acid group was significantly lower than that in the non-tranexamic acid group:45.49%(31/68)vs.68.75%(22/32),P<0.05.Postoperative drainage volume and perioperative total blood loss in the tranexamic acid group were significantly lower than those in the non-tranexamic acid group:(211.54±85.63)ml vs.(427.61±103.08)ml,(995.38±187.11)ml vs.(1276.42±236.84)ml,P<0.05.Multivariate analysis showed that age,comorbidities,and tourniquet use time,and BMI were independent risk factors affecting the increase of perioperative occult blood loss(P<0.05),and tranexamic acid was a protective factor(P<0.05).Conclusions Old age,comorbidities,excessive use time of tourniquets,and obesity can all cau

关 键 词：膝关节 关节成形术 置换 髋 氨甲环酸 失血因素 隐性出血 

分 类 号：R687.4[医药卫生—骨科学]