氨甲环酸和巴曲亭对成人大骨节病全膝关节置换术后出血量的影响  

The effect of tranexamic acid and hemocoagulase on postoperative bleeding in adult patients with Kashin-Beck disease undergoing total knee arthroplasty

作　　者：拓万宝 梁冠文 张彦祥[1] 杨龙 吕银玉 宋启春[3] Tuo Wanbao;Liang Guanwen;Zhang Yanxiang;Yang Long;Lyu Yinyu;Song Qichun(The Second Department of Orthopedics,Baoji People's Hospital,Baoji 721000,China;Department of Orthopedics,Linyou County Hospital,Baoji 721500,China;The First Department of Orthopedics,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]宝鸡市人民医院骨二科,宝鸡721000 [2]麟游县医院骨科,宝鸡721500 [3]西安交通大学附属第二医院骨一科,西安710004

出　　处：《中华地方病学杂志》2025年第1期47-51,共5页Chinese Journal of Endemiology

基　　金：中国博士后科学基金(2021M692575)。

摘　　要：目的比较氨甲环酸和巴曲亭两种止血药物对成人膝大骨节病全膝关节置换术后出血量的影响。方法采用回顾性分析,选取2021年1月至2023年3月于麟游县医院行单侧初次全膝关节置换术的成人膝大骨节病病例80例,根据纳入排除标准,排除合并慢性贫血、植入心脏支架长期口服抗凝药物和血液系统疾病病例19例,其中术前静脉应用联合术中关节腔局部应用氨甲环酸的24例病例为实验组,术前静脉应用联合术中关节腔局部应用巴曲亭的37例病例为对照组,比较两组患者术前一般情况、术后引流量、围手术期总失血量、隐性失血量、术前及术后不同时间点血红蛋白水平。结果两组患者年龄、性别分布、体重指数、术前血红蛋白水平、术前凝血酶原时间、术前活化部分凝血活酶时间比较,差异均无统计学意义(均P>0.05)。实验组病例的围手术期总失血量[(1027.78±472.71)ml]、术后48 h引流量[(336.67±112.74)ml]均低于对照组[(1390.39±454.01)、(498.65±187.57)ml],差异均有统计学意义(均P<0.05);术后第2天和第5天的血红蛋白水平均高于对照组,差异均有统计意义(均P<0.05)。结论对于成人膝大骨节病全膝关节置换术,术前静脉应用联合术中关节腔局部应用氨甲环酸优于巴曲亭,能够有效降低围手术期总失血量和术后引流量,值得在临床推广。Objective To compare the effect of two hemostatic drugs,tranexamic acid and hemocoagulase,on postoperative bleeding in adult patients with Kashin-Beck disease undergoing total knee arthroplasty.Methods A retrospective analysis was conducted to select 80 adult patients with Kashin-Beck disease who underwent unilateral primary total knee arthroplasty at Linyou County Hospital from January 2021 to March 2023.According to the inclusion and exclusion criteria,19 cases with chronic anemia,long-term oral anticoagulants implanted with cardiac stents,and hematological diseases were excluded.Among the remaining 61 adult patients,24 cases with preoperative intravenous application combined with intraoperative local application of tranexamic acid in articular cavity were selected as the experimental group,and 37 cases with preoperative intravenous application combined with intraoperative local application of hemocoagulase in articular cavity were selected as the control group.The preoperative general condition,postoperative drainage volume,total perioperative blood loss,occult blood loss,and hemoglobin levels at different time points before and after surgery were compared between the two groups of patients.Results There was no statistically significant difference in age,gender distribution,body mass index,preoperative hemoglobin level,preoperative prothrombin time,and preoperative activated partial thromboplastin time between the two groups of patients(P>0.05).The total perioperative blood loss[(1027.78±472.71)ml],drainage volume 48 h after surgery[(336.67±112.74)ml]in the experimental group were all lower than those in the control group[(1390.39±454.01),(498.65±187.57)ml],and the differences were statistically significant(P<0.05).The hemoglobin levels on the second and fifth day after surgery were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusion For total knee arthroplasty for adult patients with Kashin-Beck disease,preoperative intravenous applica

关 键 词：大骨节病 膝关节置换 氨甲环酸 巴曲亭 术后出血量 术后引流量 隐性失血量 

分 类 号：R68[医药卫生—骨科学]