氨甲环酸两种给药方法对减少全膝关节置换术出血量的对比分析  

Comparative analysis of two delivery methods of tranexamic acid for reducing bleeding in total knee arthroplasty

作　　者：赵想 戚大春[2] 安新荣[2] 高天勤[2] 徐闯[2] ZHAO Xiang;QI Dachun;AN Xinrong;GAO Tianqin;XU Chuang(Binzhou Medical College,Binzhou 256603,China;Affiliated Hospital of Binzhou Medical College,Binzhou 256603,China)

机构地区：[1]滨州医学院,山东滨州256603 [2]滨州医学院附属医院,山东滨州256603

出　　处：《药学研究》2023年第12期1035-1041,共7页Journal of Pharmaceutical Research

摘　　要：目的对比研究氨甲环酸(TXA)多次口服和多次静脉应用对全膝关节置换术中出血量的影响。方法选取我院2019年1月至2021年12月初次单侧人工全膝关节置换120例,按随机数字表法分为A、B、C、D 4组,每组30例。4组患者均于切皮前5~10 min静脉滴注TXA 1 g。A组:术后6、12、18 h分别静脉滴注TXA 1 g,B组:术后4、10、16 h分别口服TXA 2 g,C组:术后6、12、18 h分别静脉滴注等量生理盐水。D组:术后4、10、16 h分别口服等剂量的安慰剂。比较4组患者围术期一般资料,总失血量、隐性失血量、术后引流量,术后1、3 d血红蛋白、血细胞比容,术后输血率、肺栓塞、静脉血栓的发生情况。结果A组、B组围术期的总失血量:(677.50±16.59)mL、(674.97±16.41)mL;隐性失血量:(579.77±12.48)mL、(576.00±16.44)mL;术后引流量:(62.43±4.05)mL、(62.67±4.11)mL;输血率:6.6%、3.3%,均显著低于对照组C、D组,差异有统计学意义(P<0.05);A组与B组、C组与D组组间进行两两比较,差异无统计学意义(P>0.05)。术后1、3 d,A、B组血红蛋白(HB)值、血细胞比容(HCT)值,均高于C、D组,差异有统计学意义(P<0.05),A组与B组、C组与D组组间进行两两比较,差异无统计学意义(P>0.05)。4组TXA的用药成本存在显著差异,A组(438.4元/位)>B组(137.56元/位)>C组和D组(均为109.6元/位),其余一般资料均无统计学意义(P>0.05)。术后A组、D组各发生1例肌间静脉血栓,无肺栓塞发生。结论全膝关节置换术后氨甲环酸多次口服和多次静脉滴注效果相当,均可有效地减少TKA围术期的失血量、降低输血率,且不增加术后并发症的发生率。口服具有用药价格低、使用方便、无输液相关并发症等优点。Objective To compare and study the effects of multiple oral and multiple intravenous applications of tranexamic acid(TXA)on bleeding during total knee arthroplasty.Methods A total of 120 cases of initial unilateral total knee arthroplasty in our hospital from January 2019 to December 2021 were selected and divided into four groups(A,B,C and D)according to random number table method,with 30 cases in each group.All patients in the four groups were given TXA 1 g intravenously 5~10 min before incision.Group A:TXA 1 g was injected intravenously at 6,12 and 18 h,respectively,group B:TXA 2 g was administered orally at 4,10 and 16 h postoperatively,group C:equal doses of saline were administered intravenously at 6,12 and 18 h postoperatively.group D:equal doses of placebo were administered orally at 4,10 and 16 h postoperatively.Group D:equal doses of placebo were given orally at 4,10 and 16 h postoperatively.The general perioperative data,total blood loss,occult blood loss,postoperative drainage,hemoglobin and hematocrit on postoperative days 1 and 3,postoperative transfusion rate,pulmonary embolism and venous thrombosis were compared among the four groups.Results The total perioperative blood loss in groups A and B was(677.50±16.59)mL and(674.97±16.41)mL,respectively;The occult blood loss was:(579.77±12.48)mL and(576.00±16.44)mL;The postoperative drainage was(62.43±4.05)mL and(62.67±4.11)mL;The transfusion rate was 6.6%and 3.3%;All significantly lower than the control groups C and D;The difference was statistically significant(P<0.05),and the difference between group A and group B,group C and group D.There was no statistically significant difference(P>0.05)in a two-by-two comparison between group A and group B,group C and group D.The hemoglobin(HB)values and hematocrit(HCT)values in groups A and B were significantly higher than those in groups C and D at 1 and 3 days postoperatively,and the differences were statistically significant(P<0.05),and a two-way comparison between groups A and B,groups C and D showed no

关 键 词：氨甲环酸 口服 静脉滴注 多次给药 全膝关节置换术 围术期 

分 类 号：R619.1[医药卫生—外科学]