氨甲环酸给药方式对HTO失血量的影响  

Effect of tranexamic acid administration method on blood loss in HTO

作　　者：刘晓飞 李贝贝 李立[3] 马纯青 陈宏伟 马慧慧 LIU Xiaofei;LI Beibei;LI Li;MA Chunqing;CHEN Hongwei;MA Huihui(School of Medical,Fuyang Normal University,Fuyang Anhui 236041,China;The First Affiliated Hospital of Fuyang Normal University,Fuyang Anhui 236012,China;Fuyang People's Hospital,Fuyang Anhui 236012,China.)

机构地区：[1]阜阳师范大学阜阳医学院,安徽阜阳236041 [2]阜阳师范大学附属第一医院,安徽阜阳2360123 [3]阜阳市人民医院,安徽阜阳236012

出　　处：《阜阳师范大学学报(自然科学版)》2024年第4期58-64,共7页Journal of Fuyang Normal University:Natural Science

基　　金：安徽省高校科学研究重点项目(2023AH050432);阜阳师范大学横向医学研究专项培育项目(2022HXYXZX18,2021HXYXZX01ZD,2021HXYXZX09)。

摘　　要：探讨氨甲环酸(Tranexamic acid)不同给药方式在胫骨高位截骨术(High Tibial osteotomy)治疗内翻型膝关节骨性关节炎中的临床疗效。回顾性分析符合研究纳入标准内翻型膝关节骨性关节炎行HTO患者95例,根据TXA使用情况分为:A组(不使用,n=30),B组(静脉滴注,n=34,术前30 min 2 g TXA溶于100 mL生理盐水),C组(局部应用,n=31,2 g TXA溶于20 mL生理盐水,切口关闭后由引流管注入切口)。记录手术时间、术中出血量、术后引流量、术后输血、切口及其他并发症,有症状的静脉血栓栓塞症(VTE),根据身高、体重、术前血红蛋白浓度与术后最低血红蛋白浓度计算患者总失血量;并记录术前1天,术后1月、3月、6月美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS评分)以及术前1天,术后1天、3天、1月、3月、6月视觉模拟评分法(Visual Analogue Scale,VAS)。B组和C组总失血量小于A组,B组和C组差异无统计学意义[(712.04±124.35) mL vs (431.26±88.15) mL vs (488.59±149.16) mL,PAB<0.05,PAC<0.05,PBC>0.05)];三组患者均未输血及出现血管事件,术前1天、术后3月、术后6月患肢HSS评分无明显差异,术后1月HSS评分A组较B组和C组低(P<0.05),B组和C组差异无统计学意义;术前1天,术后3月、6月VAS评分三组无明显差异,B组和C组术后1天、3天、1月VAS评分较A组低(P<0.05),B组和C组无统计学差异。静脉、局部应用TXA均可减少膝内翻型骨性关节炎行HTO围手术期失血量,且不增加术后静脉血栓栓塞症风险,但静脉、局部应用对减少围术期失血量效果无明显差异。To discuss the clinical efficacy of different administration methods of tranexamic acid(TXA) in the treatment of varus knee osteoarthritis by high tibial osteotomy(HTO). A retrospective analysis of 95 patients with varus knee osteoarthritis who underwent HTO met the inclusion criteria. According to the TXA usage, they were divided into: Group A(not used, n=30),group B(intravenous infusion, n=34, 2 g TXA dissolved in 100 mL saline 30 min before surgery), group C(topical application,n=31, 2 g TXA dissolved in 20 mL saline, the incision was closed and then injected into the incision by the drainage tube). We recorded operation time, intraoperative blood loss, postoperative drainage, postoperative blood transfusion, incision and other complications, and symptomatic venous thromboembolism(VTE), calculated the patient ' s total blood loss based on blood volume, preoperative hemoglobin concentration and postoperative minimum hemoglobin concentration;and recorded Special Surgery Knee Score(HSS score) of one day before surgery and the first, third, and sixth postoperative month, and Visual Analogue Scale(VAS) of one day before surgery and the first, third postoperative day, the first, third, and sixth postoperative month. The total blood loss of group B and group C is less than that of group A, while the difference between group B and group C has no statistical significance [(712.04±124.35 mL)vs(431.26±88.15 mL)vs(488.59±149.16 mL),PAB <0.05, PAC <0.05,PBC >0.05)]. There were no blood transfusions and vascular events in three groups. There was no significant difference in the HSS scores of the affected limbs 1 day before surgery, 3 months and 6 months after surgery. The HSS scores in group A were lower than those in groups B and C at 1 month after surgery( P<0.05), but there was no statistically significant difference between group B and C. There was no significant difference in the VAS scores at 1 day before surgery,3 months and 6 months after surgery. The VAS scores at 1 day, 3 days, and 1 month after operation in gr

关 键 词：胫骨高位截骨术 氨甲环酸 膝关节骨性关节炎 失血 

分 类 号：R-687[医药卫生]