摘要
目的探讨人工全膝关节置换术（total knee arthroplasty,TKA）中静脉应用氨甲环酸（tranexamic acid,TXA）减少围手术期失血量的安全性和临床疗效。方法采用前瞻性自身对照方法,选取2012年1月-2013年12月拟分期行双侧TKA患者60例,随机选择一侧手术时使用TXA（TXA组）,另一侧手术时不用TXA（对照组）。TXA剂量为10 mg/kg,于松开止血带前10 min内静脉滴注完毕。两组术前血红蛋白（hemoglobin,Hgb）、血小板计数、凝血酶原时间、活化部分凝血活酶时间比较,差异均无统计学意义（P〉0.05）。比较TXA组与对照组引流量、总失血量、隐性失血量、术后不同时间点Hgb、输血量、输血比例及静脉血栓栓塞（venous thrombus embolism,VTE）发生情况。结果 TXA组引流量、总失血量均低于对照组,术后6 h及1、3、7 d Hgb高于对照组,比较差异均有统计学意义（P〈0.05）。两组隐性失血量比较,差异无统计学意义（t=1.157,P=0.252）。TXA组4例（6.7%）、对照组13例（21.7%）患者术后行输血治疗,差异有统计学意义（P=0.034）;其中4例为两次手术均需输血。TXA组的总输血量为14 U,较对照组的38 U显著降低（P=0.004）。TXA组及对照组各3例（5.0%）发生术侧下肢深静脉血栓（deep vein thrombosis,DVT）,均无症状性肺动脉栓塞发生,VTE发生率比较差异无统计学意义（P=1.000）;其中2例两次手术均发生DVT。患者均获随访,随访时间8-17个月,平均13.7个月;随访期间均无新发VTE。结论 TKA术中松止血带前10 min内静脉滴注TXA（10 mg/kg）能有效减少围手术期失血量,降低输血量及输血患者比例,且不增加VTE发生风险。
Objective To investigate the safety and efficiency of intravenous tranexamic acid （TXA） to reduce blood loss in total knee arthroplasty （TKA）. Methods A prospective, randomized, self-controlled study was carried out on 60 patients scheduled for bilateral TKA between January 2012 and December 2013. TXA （10 mg/kg） was injected intravenously approximately 10 minutes before tourniquet release when TKA was performed on one side （TXA group）, and TXA was not used on the other side （control group）. No significant difference was found in the preoperative hemoglobin （Hgb）, platelet （PLT） count, prothrombin time （PT）, and activated partial thromboplastin time （APTT） between 2 groups （P〉O.05）. The amount of drainage, the total blood loss, the hidden blood loss, the postoperative Hgb, the amount of blood transfusion, the ratio of blood transfusion, and the incidence of vein thrombosis embolism （VTE） were compared between 2 groups. Results The amount of drainage and total blood loss were significantly less in the TXA group than in control group （P〈0.05）, and the Hgb was significantly lower in the control group than in the TXA group at 6 hours, 1, 3, and 7 days after operation （P〈0.05）. There was no significant difference in the hidden blood loss between 2 groups （t=1.157, P=0.252）. The ratio of blood transfusion was significantly less in TXA group （6.7%, 4/60） than in control group （21.7%, 13/60）（P=0.034）. The total amount of blood transfusion was 14 units in TXA group, which was significantly less than that of control group （38 units） （P=0.004）. Deep vein thrombosis occurred in 3 cases in 2 groups respectively, showing no significant difference（P=I.000）. There was no symptomatic pulmonary embolism. All patients were followed up for 8-17 months, with an average of 13.7 months. No new VTE case was found during the follow-up period. Conclusion Intravenous injection of TXA （10 mg/kg） at 10 minutes before tourniquet release in TKA is effective in reducing perioperative blood loss, amount of blood transfusion, and ratio of transfusion, and it will not increase the risk of VTE.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第3期280-283,共4页
Chinese Journal of Reparative and Reconstructive Surgery
基金
福建省科技厅国际合作重点课题(2013I0002)
福建省临床重点专科建设项目~~
作者简介
通信作者：张文明，主任医师，硕士生导师，研究方向：关节外科，E-mail：Zhangwm0591@163．com
