关节腔灌注氨甲环酸对全髋关节置换术后患者隐性失血的影响  

Effect of intra-articular infusion of tranexamic acid on hidden blood loss in patients after total hip arthroplasty

作　　者：顾荣胜[1] 陆华[1] 陈大志[1] 孟庆国[1] 祁兆建[1] 范广峰 田敏[1] GU Rongsheng;LU Hua;CHEN Dazhi;MENG Qingguo;QI Zhaojian;FAN Guangfeng;TIAN Min(Yancheng Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Yancheng 224001,China)

机构地区：[1]南京中医药大学附属盐城中医院,江苏盐城224001

出　　处：《临床医学研究与实践》2023年第11期42-45,共4页Clinical Research and Practice

摘　　要：目的观察关节腔灌注氨甲环酸对全髋关节置换术(THA)后患者隐性失血(HBL)的影响,并评估氨甲环酸的临床应用安全性。方法选取2018年1月至2020年12月在我科接受THA的42例患者为研究对象,随机将其分为观察组(n=21)和对照组(n=21)。在切口关闭后,观察组向关节腔灌注氨甲环酸100 mL(2 g),对照组向关节腔灌注0.9%氯化钠100 mL。比较两组的总失血量、显性失血量、术后HBL量、输血量、血常规指标、凝血功能指标及术后并发症发生情况。结果观察组的总失血量、显性失血量、术后HBL量和输血量均少于对照组(P<0.05)。两组术后第3天的血红蛋白(Hb)、红细胞比容(Hct)均低于术前(P<0.05);观察组术后第3天的Hb、Hct高于对照组(P<0.05)。术后第3天,两组的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及纤维蛋白原(FIB)水平比较,差异无统计学意义(P>0.05)。观察组的皮下瘀血发生率及并发症总发生率低于对照组(P<0.05)。结论关节腔灌注氨甲环酸能够明显减少THA患者的失血量及并发症发生情况,且对凝血功能无明显影响。Objective To observe the effect of intra-articular infusion of tranexamic acid on hidden blood loss(HBL)in patients after total hip arthroplasty(THA),and evaluate the safety of clinical application of tranexamic acid.Methods Forty-two patients who underwent THA in our department from January 2018 to December 2020 were selected as the study objects and randomly divided into observation group(n=21)and control group(n=21).After the incision was closed,100 mL(2 g)of tranexamic acid was infused into the joint cavity in the observation group,and 100 mL of 0.9%sodium chloride was infused into the joint cavity in the control group.The total blood loss,dominant blood loss,postoperative HBL volume,blood transfusion volume,blood routine indexes,coagulation function indexes and occurrence of postoperative complications were compared between the two groups.Results The total blood loss,dominant blood loss,postoperative HBL volume and blood transfusion volume in the observation group were lower than those in the control group(P<0.05).The hemoglobin(Hb)and hematocrit(Hct)on the 3rd day after operation in both groups were lower than those before operation(P<0.05);the Hb and Hct in the observation group on the 3rd day after operation were higher than those in the control group(P<0.05).On the 3rd day after operation,there were no statistically significant differences in prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen(FIB)level between the two groups(P>0.05).The incidence of subcutaneous blood stasis and total incidence of complications in the observation group were lower than those in the control group(P<0.05).Conclusion The intra-articular infusion of tranexamic acid can significantly reduce blood loss and complications in patients with THA,and has no significant impact on coagulation function.

关 键 词：全髋关节置换术 氨甲环酸 关节腔灌注 隐性失血 凝血功能 

分 类 号：R687.4[医药卫生—骨科学]