摘要
背景:骨科关节置换后隐性失血导致严重的贫血,需输血纠正,氨甲环酸的使用能明显减少围手术期失血,减少输血率,但氨甲环酸对隐性失血的作用机制及关联性不清。目的:通过建立人工膝关节置换兔模型,观察使用氨甲环酸后早期围手术期失血的变化,探讨氨甲环酸对隐性失血的作用以及对下肢深静脉血栓的影响。方法:自行设计完成兔膝关节假体,20只成年新西兰兔随机分成两组,每组10只,均进行同一侧膝关节置换,实验组在置换前15 min给予0.5 g 100 m L的氨甲环酸静滴补液,对照组于相同时间给予100 mL的氯化钠。所有动物于置换前1 d,置换后3 h,6 h,24 h,48 h,72 h,第7天分别进行耳缘静脉采血,进行血常规及凝血功能检查,测定血浆D-D二聚体的含量,同时记录手术时间及术中出血量,置换后进行下肢静脉超声检查的筛选。结果与结论:两组置换前体质量、血红蛋白、红细胞压积和D-D二聚体水平差异无显著性意义(P>0.05)。两组手术时间以及术中显性失血量的差异有显著性意义(P<0.05),置换后24 h的血红蛋白和红细胞压积值比较差异有显著性意义(P<0.05),实验组优于对照组。两组置换后D-D二聚体差异无显著性意义(P>0.05)。手术时间、术中显性失血与置换后24 h的血红蛋白、红细胞压积值具有明显相关性(P<0.05),与置换后72 h、第7天的血红蛋白、红细胞压积值变化以及围手术期D-D二聚体的变化无明显相关性。置换后下肢静脉超声检查未发现明显的血栓。提示全膝关节置换前氨甲环酸的使用可以明显减少术中显性失血,缩短手术时间,能够显著减少置换后第1天的隐性失血量,这由于手术应激后纤维蛋白溶解增加引起的,对非该机制引起的其他隐性失血无明显作用。同时氨甲环酸的安全性可靠,不增加围手术期血栓风险。
BACKGROUND： Hidden blood loss leads to severe ~nemia after orthopedic joint arthroplasty. Blood transfusion is needed. Use of tranexamic acid can significantly decrease perioperative blood loss, reduce blood transfusion rate, however, mechanism of action of tranexamic acid on hidden blood loss and its relevance are not clear. OBJECTIVE： By establishing the rabbit models of total knee prosthesis, this study was designed to observe the variation of early preoperative blood loss with tranexamic acid, and to study the effects of tranexamic acid on hidden blood loss and its influence on deep venous thrombosis of lower limb. METHODS： We designed the rabbit knee prosthesis ourselves. A total of 20 adult New Zealand rabbits were randomly divided into two groups, each group with 10 rabbits. Knee arthroplasty on the same side was performed. Experimental group received intravenous injection of 0.5 g 100 mL tranexamic acid at 15 minutes before replacement. Control group was given 100 mL sodium chloride at the same time. Blood was collected from all animals through ear vein at 1 day before replacement, 3, 6, 24, 48, 72 hours and 7 days after replacement. Blood routine examination and blood coagulation function test were conducted. The content of plasma D-Dimer was determined. Simultaneously, the operation time and intraoperative bleeding amount were recorded. After replacement, lower limb venous ultrasonography was performed. RESULTS AND CONCLUSION： No significant difference in body weight, hemoglobin, hematocrit, and D-Dimer levels was detected between the two groups before replacement （P 〉 0.05）. Significant differences in operation time and intreoperetive dominant blood loss were detectable between the two groups （P 〈 0.05）. Significant differences in hemoglobin and hematocrit were detected at 24 hours after replacement （P 〈 0.05）, and these were better in the experimental group than in the control group. No significant difference in D-Dimer was observed between the two groups after replacement （P 〉 0.05）. Operation time and intraoperative dominant blood loss were significantly associated with hemoglobin and hematocrit at 24 hours after replacement （P 〈 0.05）. The changes in hemoglobin and hematocrit at 72 hours and 7 days after replacement were not apparently correlated with intraoperetive D-Dimer changes. Obvious thrombus was not seen by lower limb venous ultresonography after replacement. These results indicated that the use of trenexamic acid before total knee arthroplasty apparently reduced the intraoperative dominant blood loss, shortened operation time, and noticeably decreased hidden blood loss at 1 day after replacement, which was caused by the increased flbrinolysis with surgical stress, and did not apparently impact other hidden blood loss induced by other mechanism. Simultaneously, tranexamic acid is safe and reliable, and does not increase the risk of perioperative thrombus.
出处
《中国组织工程研究》
CAS
北大核心
2015年第17期2648-2654,共7页
Chinese Journal of Tissue Engineering Research
基金
江苏省临床医学科技专项资助(BL2012002)~~
作者简介
袁磊，男，1989年生，江苏省常州市人，汉族，南京大学医学院在读硕士，主要从事骨科关节方面研究。
通讯作者：赵建宁，主任，主任医师，教授，博士生导师，南京大学医学院临床学院，解放军南京军区南京总医院骨科，江苏省南京市210002
