血友病性关节炎患者全膝置换术中应用氨甲环酸的疗效观察  

Observation of the efficacy of tranexamic acid during total knee replacement in patients with hemophilic arthritis

作　　者：韩绍芹[1] 张文强 孟洪正 张明 刘毅 HAN Shaoqin;ZHANG Wenqiang;MENG Hongzheng;ZHANG Ming;LIU Yi(Shandong Provincial Blood Center,Jinan 250013,Shandong,P.R.China;The First Affiliated Hospital of Shandong First Medical University,Jinan 250014,Shandong,P.R.China;Shandong Public Health Clinical Center,Jinan 250102,Shandong,P.R.China)

机构地区：[1]山东省血液中心,山东济南250013 [2]山东第一医科大学第一附属医院,山东济南250014 [3]山东省公共卫生临床中心,山东济南250102

出　　处：《滨州医学院学报》2024年第6期491-494,共4页Journal of Binzhou Medical University

基　　金：山东省自然科学基金面上项目(ZR2022MH299);山东省自然科学基金面上项目(ZR2021MH166)。

摘　　要：目的探讨血友病性关节炎患者在全膝关节置换术(total knee arthroplasty,TKA)中静脉联合局部应用氨甲环酸(tranexamic acid,TXA)的临床疗效和安全性。方法回顾性分析2016年1月—2021年6月山东第一医科大学第一附属医院69例行TKA的血友病性关节炎患者的临床资料。根据是否使用TXA,将患者分为氨甲环酸组(TXA组)36例和对照组33例。比较两组患者的总失血量、术中失血量、隐性失血量、术后血红蛋白水平、凝血因子的使用总量、炎症生物标志物、膝关节活动度(range of motion,ROM)、膝关节功能评分、视觉模拟评分(visual analogue scale,VAS)、并发症发生率。结果TXA组在总失血量、术中失血量和隐性失血量方面均低于对照组(P<0.05);TXA组在术后C-反应蛋白、早期VAS评分、肢体肿胀率和早期膝关节ROM方面均优于对照组(P<0.05)。两组患者在膝关节功能评分和末次随访时膝关节活动度方面,差异无统计学意义(P>0.05)。此外,两组患者在凝血因子使用总量方面,差异无统计学意义(P>0.05)。结论血友病性关节炎患者在TKA中静脉联合局部应用TXA能有效减少术后出血量、术后早期炎症水平、疼痛和肢体肿胀,从而使患者获得更好的早期膝关节ROM,且并不增加术后并发症的发生率。Objective To explore the clinical efficacy and safety of intravenous combined with local application of tranexamic acid(TXA)in patients with hemophilic arthritis undergoing total knee arthroplasty.Methods A retrospective analysis was conducted on the clinical data of 69 patients with hemophilia who underwent total knee arthroplasty at the First Affiliated Hospital of Shandong First Medical University from January 2016 to June 2021.According to whether TXA was used or not,patients were divided into thetranexamic acid group(TXA group)with 36 cases and the control group with 33 cases.Total blood loss,intraoperative blood loss,occult blood loss,postoperative hemoglobin,total amount of coagulation factor used,inflammatory biomarkers,knee joint range of motion(ROM),knee joint function score,VAS score,and incidence of complications were compared between the two groups of patients.Results The TXA group showed significantly lower total blood loss,intraoperative blood loss,and occult blood loss compared to the control group(P<0.05).The TXA group showed better postoperative CRP,early VAS score,limb swelling rate,and early knee ROM compared to the control group(P<0.05).There was no statistically significant difference between the two groups of patients in terms of knee joint function score and knee joint range of motion at the last follow-up(P>0.05).In addition,there was no significant difference in the total amount of coagulation factors used between the two groups(P>0.05).Conclusion Intravenous combi ned with local application of tranexamic acid in total knee arthroplasty for hemophilia patients can effectively reduce postoperative bleeding,early postoperative inflammation levels,pain,and limb swelling,thereby enabling patients to achieve better early knee joint mobility without increasing the incidence of postoperative complications.

关 键 词：血友病性关节炎 氨甲环酸 全膝关节置换术 出血量 

分 类 号：R687.4[医药卫生—骨科学]