氨甲环酸联合不同抗凝药对全膝关节置换术围手术期失血量的影响  

Effects of tranexamic acid and different anticoagulants on perioperative blood loss in total knee arthroplasty

作　　者：陈森荣 肖军[1] 李强[3] 胡勇[4] 史占军[1] Chen Senrong;Xiao Jun;Li Qiang;Hu Yong;Shi Zhanjun(Department of Orthopedics,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Orthopedics,the Third Affiliated Hospital of Guangdong Medical University(Longjiang Hospital,Shunde District,Foshan City),Foshan 523819,China;Department of Orthopedics,Huaihua Hospital of Traditional Chinese Medicine,Huaihua 418000,China;Department of Orthopedics,the Fifth Hospital of Southern Medical University,Guangzhou 510900,China)

机构地区：[1]南方医科大学南方医院关节与骨病外科,广州510515 [2]广东医科大学附属第三医院(佛山市顺德区龙江医院)骨科,广东佛山523819 [3]怀化市中医院关节外科,湖南怀化418000 [4]南方医科大学第五医院关节外科,广州510900

出　　处：《中国临床解剖学杂志》2022年第3期356-361,共6页Chinese Journal of Clinical Anatomy

摘　　要：目的探讨氨甲环酸与不同抗凝药联用对全膝关节置换术围手术期失血量的影响。方法纳入2014年10月至2019年10月初次行全膝关节置换术并符合标准的158例膝骨性关节炎患者,按氨甲环酸注射方法及术后使用抗凝药分为4组:A组,术中静脉注射氨甲环酸+术后利伐沙班抗凝;B组,术中静脉注射氨甲环酸+术后依诺肝素抗凝;C组,术中静脉+局部注射氨甲环酸+术后利伐沙班抗凝;D组,术中静脉+局部注射氨甲环酸+术后依诺肝素抗凝。各组患者一般情况、术前准备、手术方式及术后处理一致,比较其失血量、凝血功能、输血及围手术期不良事件的发生率。结果联合使用氨甲环酸的患者能有效控制总出血量、显性出血量、输血率及血浆D二聚体;术后使用利伐沙班或依诺肝素抗凝,出血量、输血率及围手术期不良事件发生率相当。结论TKA术中应用氨甲环酸静脉+局部注射能有效减少围手术期的失血量、输血率及血浆D二聚体;术后使用利伐沙班或依诺肝素进行抗凝,两者对失血量及围手术期不良事件发生率的影响无明显差异。Objective To investigate the effect of tranexamic acid and different anticoagulants on blood loss during the perioperative period of total knee arthroplasty.Methods A total of 158 patients with knee osteoarthritis who underwent total knee arthroplasty(TKA)from October 2014 to October 2019 and met the criteria were enrolled.According to different tranexamic acid injection methods and postoperative use of different anticoagulants,they were divided into four group:Group A:intraoperative intravenous injection of tranexamic acid+postoperative rivaroxaban anticoagulation;Group B:intraoperative intravenous injection of tranexamic acid+postoperative enoxaparin anticoagulation;Group C:intraoperative vein injection+local injection of tranexamic acid+postoperative rivaroxaban anticoagulation;Group D:intraoperative intravenous injection+local injection of tranexamic acid+postoperative enoxaparin anticoagulation.The preoperative preparations,intraoperative and postoperative treatments of the patients in each group were the same.The general information,intraoperative conditions,blood loss,blood coagulation function,blood transfusion and incidence of perioperative adverse events were compared in the four groups.Results The combined use of tranexamic acid could further reduce total bleeding,overt bleeding,blood transfusion rate and plasma D dimerization body(P<0.05).After the use of rivaroxaban for anticoagulation,the bleeding volume,blood transfusion rate and perioperative adverse event rate were equivalent to enoxaparin.Conclusions The application of intravenous tranexamic acid combined with local injection during TKA can further effectively reduce the blood loss,transfusion rate and Plasma D dimer during the perioperative period.Rivaroxaban or enoxaparin is used for anticoagulation after operation,there is no significant difference in the blood loss and the incidence rate of perioperative adverse events.

关 键 词：全膝关节置换术 氨甲环酸 抗凝药物 围手术期 失血量 

分 类 号：R687.4[医药卫生—骨科学]