摘要
背景:氨甲环酸(TXA)能有效减少全髋关节置换术(THA)围手术期出血量,且不增加静脉血栓栓塞症(VTE)发生风险。但TXA对于合并致VTE形成高危并存疾病患者行THA的安全性和有效性尚不明确。目的:评价TXA对于合并致VTE形成高危并存疾病患者THA的安全性和有效性。方法:查阅文献,设定致THA术后VTE形成风险增加的术前并存疾病。根据围手术期应用TXA与否及应用方法(静脉或局部)分为对照组(未应用TXA)、静脉组(静脉应用TXA)和局部组(局部应用TXA)。本研究的安全性指标为VTE发生情况,包括深静脉血栓(DVT)及肺栓塞(PE);有效性指标为输血率。结果:回顾性分析2008年1月至2018年4月收治的8265例初次THA患者的资料,最终纳入815例合并致VTE形成高危并存疾病的初次单侧THA患者。未接受TXA的315例对照组,接受静脉TXA的221例为静脉组,接受局部TXA的279例为局部组。对照组、静脉组和局部组分别有27例(8.6%)、17例(7.7%)、22例(7.9%)发生VTE事件,组间比较差异无统计学意义(P>0.05)。DVT、PE发生率进行组间比较,差异均无统计学意义(P>0.05)。静脉组及局部组输血率为11.8%和15.8%,均明显低于对照组的28.9%,差异有统计学意义(P<0.05)。结论:对于术前合并致VTE高危并存疾病的THA患者,静脉及局部应用TXA均不增加THA围手术期VTE发生风险,且能有效减少围手术期输血率,此类患者行THA术中应用TXA安全有效。
Background: Tranexamic acid(TXA) can effectively reduce perioperative blood loss in total hip arthroplasty(THA) and do not increase the risk for venous thromboembolism(VTE). However, the safety and effect of TXA in patients with high risk comorbidities for VTE are still not clear. Objective: To investigate the safety and effect of TXA in patients with high risk comorbidities for VTE. Methods: Literature was reviewed and high risk comorbidities possiblly leading to increased risk for postoperative venous thromboembolism were defined. The patients were divided into intravenous TXA group, topical TXA group and the control group(without TXA). The safety outcomes were identified as the rates of VTE and pulmonary embolism(PE), and the efficacy outcome was rate of transfusion. Results: Through a retrospective review of 8265 patients undergoing primary THA from January to April 2018, 815 patients undergoing primary unilateral THA who had the high risk comorbidities for VTE were included. Of them, 315 patients not receiving TXA were considered as control group, 221 patients receiving intravenous TXA were considered as intravenous TXA group, and 279 patients receiving topical TXA were considered as topical TXA group. The incidences of VTE in control, intravenous TXA, and topical TXA groups were 8.6%(n=27), 7.7%(n=17)and 7.9%(n=22) respectively, and the differences were not statistically significant(P>0.05). Further stratification analysis showed that there was no significant differences in DVT and PE among the groups. The transfusion rate was lower in intravenous and topical TXA groups than in the control group(11.8%, 15.8% vs. 28.9%, P<0.05). Conclusions: For patients with high risk comorbidities for VTE undergoing THA, their perioperative VTE risks do not increase when using intravenous or topical TXA, and their perioperative transfusion rates can also be reduced. TXA is safe and effect for these patients in THA.
作者
海洋
岳辰
刘又文
康鹏德
HAI Yang;YUE Chen;LIU Youwen;KANG Pengde(Department of Hip Injury Center,Luoyang Orthopaedic Hospital of Henan Province,Luoyang 471000,Henan;Department of Orthopaedic Surgery,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《中华骨与关节外科杂志》
2020年第6期452-455,共4页
Chinese Journal of Bone and Joint Surgery
基金
四川大学华西医院学科卓越发展1·3·5工程项目(ZYJC18040)
作者简介
第一作者:海洋;第一作者:岳辰;通信作者:刘又文,E-mail:lyworthopedic@163.com;通信作者:康鹏德,E-mail:kangpdhuaxi@sina.com
