氨甲环酸分别联合阿司匹林、低分子肝素钙在全膝关节置换术血液管理中的效果分析  

Effect analysis of tranexamic acid combined with aspirin and low molecular weight heparin calcium in blood management of total knee arthroplasty

作　　者：王汉伟 程坤 张文佳 郭旭 李锦梅 卢吉高 WANG Hanwei;CHENG Kun;ZHANG Wenjia;GUO Xu;LI Jinmei;LU Jigao(Department of Elderly Orthopedics,Zhangjiakou Second Hospital,Zhangjiakou 075000,China;不详)

机构地区：[1]河北省张家口市第二医院老年骨科,075000 [2]河北省张家口市第二医院骨肿瘤骨结核科,075000

出　　处：《临床外科杂志》2024年第5期521-524,共4页Journal of Clinical Surgery

基　　金：张家口市2022年市级科技计划自筹经费项目(2221223D)。

摘　　要：目的探讨氨甲环酸分别联合阿司匹林、低分子肝素钙调控炎症介质、血栓弹力图(TEG)在全膝关节置换术(TKA)血液管理中的价值。方法2020年1月~2022年10我院拟行TKA老年病人120例,电脑随机数字法分为A组(60例)和B组(60例),分别给予氨甲环酸+阿司匹林、氨甲环酸+低分子肝素钙,均治疗2周。比较两组围术期指标、并发症[下肢深静脉血栓(DVT)、肌间静脉血栓(MCVT)、切口感染]、输血率、不良反应(胃肠不适、皮下瘀斑)及TEG参数[凝血反应时间(R)、血液凝固时间(K)、最大振幅(MA)、凝固角(α角)]、炎症介质[可溶性CD40配体(sCD40L)、Toll样受体4(TLR4)、肿瘤坏死因子(TNF)-α]、血管内皮损伤因子[可溶性血栓调节蛋白(sTM)、血管内皮细胞生长因子(VEGF)、E-选择素]。结果两组术后24小时引流量、隐性失血量、总失血量、术中出血量、术后72小时Hb及HCT水平比较,差异无统计学意义(P>0.05);两组组间、不同时间点及组间·不同时间点交互TEG参数比较,差异无统计学意义(P>0.05);术后2周A组血清TLR4、sCD40L、TNF-α水平较B组降低,血浆sTM及血清VEGF、E-选择素水平较B组降低,差异有统计学意义(P<0.05);A组DVT、MCVT、切口感染发生率、输血率与B组比较,差异无统计学意义(P>0.05);A组不良反应总发生率与B组比较,差异无统计学意义(P>0.05)。结论与联合低分子肝素钙比较,氨甲环酸联合阿司匹林能保护血管内皮,抑制炎症反应,但两者均可维持病人凝血功能,避免大量失血或血栓形成,在安全性与有效性方面无显著差异。Objective To investigate the value of tranexamic acid combined with aspirin,low molecular weight heparin calcium in regulating inflammatory mediators and TEG in blood management of Total knee arthroplast(TKA).Methods 120 elderly patients with TKA in our hospital from January 2020 to October 2022 were randomly divided into group A(n=60)and group B(n=60).They were given tranexamic acid+aspirin and tranexamic acid+low molecular weight heparin calcium,respectively,for 2 weeks.Perioperative indexes,complications[lower limb deep vein thrombosis(DVT),intermuscular vein thrombosis(MCVT),incision infection],blood transfusion rate,adverse reactions(gastrointestinal discomfort,subcutaneous ecchymosis),TEG parameters[coagulation reaction time(R),blood coagulation time(K),maximum amplitude(MA),coagulation angle(α)],inflammatory mediators[soluble CD40 ligand(sCD40L),Toll-like receptor 4(TLR4),tumor necrosis factor(TNF-α)],vascular endothelial injury factors[soluble thromboregulatory protein(sTM),vascular endothelial cell growth factor(VEGF),E-selectin]were compared between the two groups.Results There was no significant difference in the 24 h postoperative drainage volume,latent blood loss,total blood loss,intraoperative blood loss,Hb and HCT levels 72 h after surgery between the two groups(P>0.05).There was no statistically significant difference in TEG parameters between the two groups,at different time points,and between groups at different time points(P>0.05);The serum levels of TLR4,sCD40L and TNF-αin group A were lower than those in group B 2 weeks after surgery(P<0.05).The levels of plasma sTM and serum VEGF and E-selectin in group A were lower than those in group B 2 weeks after surgery(P<0.05).There was no significant difference in the incidence of deep vein thrombosis(DVT),intermuscular vein thrombosis(MCVT),incision infection and blood transfusion rate between group A and group B(P>0.05).There was no significant difference in the total incidence of adverse reactions between group A and group B(P>0.05).Conclusion

关 键 词：全膝关节置换术 氨甲环酸 阿司匹林 低分子肝素钙 输血率 血管内皮损伤因子 

分 类 号：R54[医药卫生—心血管疾病]