氨甲环酸和氨基己酸在全膝关节置换围术期应用的有效性与安全性  

Efficacy and safety of tranexamic acid and aminocaproic acid in perioperative period of total knee arthroplasty

作　　者：阿里木江·玉素甫 阿卜杜吾普尔•海比尔 覃祺 刘宇哲 张乾龙 冉建[1] Alimujiang•Yusufu;Abuduwupuer•Haibier;Qin Qi;Liu Yuzhe;Zhang Qianlong;Ran Jian(Department of Trauma and Orthopedics,Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830002,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆医科大学第六附属医院创伤骨科,新疆维吾尔自治区乌鲁木齐市830002

出　　处：《中国组织工程研究》2023年第36期5812-5817,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:抗纤溶药物被广泛用于减少全膝关节置换过程中的失血量,氨甲环酸和氨基己酸在全膝关节置换过程中的止血疗效虽然已被证实,但是二者孰优孰劣尚存在争议。目的:比较氨甲环酸和氨基己酸在全膝关节置换围术期中应用的安全性及有效性。方法:回顾性筛选2021年4月至2022年6月于新疆医科大学第六附属医院行单侧全膝关节置换的102例患者,根据围术期中应用的抗纤溶止血药物不同分成2组,其中氨基己酸组49例,氨甲环酸组53例,且两组均为静脉和局部联合用药。对比两组患者在全膝关节置换围术期的各项失血及凝血指标、术后住院时间和术后各项并发症的发生情况。结果与结论:(1)术前资料:两组患者的年龄、性别构成、体质量指数、高血压、糖尿病、手术时间以及红细胞、血红蛋白、红细胞压积、白蛋白、凝血酶原活动度、国际化标准比和D-二聚体指标相比差异均无显著性意义(P>0.05);(2)失血及凝血指标:氨甲环酸组和氨基己酸组的总失血量、隐性失血量差异有显著性意义(P<0.05);两组间的估算血容量、显性失血量以及术后引流量差异均无显著性意义(P>0.05);两组患者术后第1,5天红细胞、血红蛋白、红细胞压积、白蛋白、血清铁蛋白、D-二聚体、凝血酶原活动度以及国际化标准比,差异均无显著性意义(P>0.05);(3)输血情况:氨甲环酸组输血量明显小于氨基己酸组,差异有显著性意义(P<0.05);两组间输血率相比差异无显著性意义(P>0.05);(4)两组患者的术后住院时间及术后并发症发生情况相比,差异均无显著性意义(P<0.05);(5)结果表明,氨甲环酸在全膝关节置换围术期中应用的止血效果比氨基己酸更强,且该试验证明两种药物的安全性基本一致;因此在全膝关节置换围术期中作者建议首选氨甲环酸作为抗纤溶止血药物。BACKGROUND:Antifibrinolytic drugs are widely used to reduce blood loss in total knee arthroplasty.Although the hemostatic effect of tranexamic acid and aminocaproic acid in total knee arthroplasty has been confirmed,which is superior or inferior is still controversial.OBJECTIVE:To compare the safety and effectiveness of tranexamic acid and aminocaproic acid in the perioperative period of total knee arthroplasty.METHODS:102 patients undergoing unilateral total knee arthroplasty in the Sixth Affiliated Hospital of Xinjiang Medical University from April 2021 to June 2022 were retrospectively screened.These patients were divided into two groups according to different antifibrinolytic hemostatic agents applied during the perioperative period.Of these,49 patients used aminhexic acid and 53 patients used tranexamic acid.Both groups received intravenous and topical combinations.The blood loss and coagulation indexes,postoperative hospital stay and postoperative complications in the perioperative period of total knee arthroplasty were compared between the two groups.RESULTS AND CONCLUSION:(1)Preoperative data:No significant differences in age,gender composition,body mass index,hypertension,diabetes mellitus,operation time,erythrocytes,hemoglobin,hematocrit,albumin,prothrombin activity,international standard ratio,or D-dimer index were found between the two groups(P>0.05).(2)Blood loss and coagulation indexes:There were significant differences in total blood loss and recessive blood loss between the tranexamic acid group and the aminocaproic acid group(P<0.05).There was no significant difference in estimated blood volume,dominant blood loss and postoperative drainage between the two groups(P>0.05).There was no significant difference in erythrocyte,hemoglobin,hematocrit,albumin,serum ferritin,D-dimer,prothrombin activity and international standard between the two groups at 1 and 5 days after operation(P>0.05).(3)Blood transfusion:The amount of blood transfusion in the tranexamic acid group was significantly less than that i

关 键 词：氨甲环酸 氨基己酸 全膝关节置换 出血量 膝关节骨性关节炎 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687