摘要
背景:全膝关节置换围手术期出血较多,而输血不仅额外增加费用,延长康复时间,也存在免疫反应和传染疾病的风险。因此,减少全膝关节置换失血量显得十分重要。目的:评估氨甲环酸在全膝关节置换中止血的有效性和安全性。方法:将64例因骨关节病拟行单侧全膝关节置换的患者随机分为两组,每组32例。氨甲环酸组于置换前15 min将氨甲环酸按10 mg/kg稀释于250 mL等渗盐水中静脉滴注;对照组同时间点给予等量生理盐水。对比术中失血量、置换后可见失血量、置换后血红蛋白减少量、输血量、输血人数和置换后纤维蛋白原、凝血酶原时间等凝血评价指标。观察置换后下肢深静脉栓塞的症状,并在置换后30 d行下肢血管多普勒检查。结果与结论:两组术中出血量差异无显著性意义(P>0.05),氨甲环酸组置换后可见失血量低于对照组(P<0.001),氨甲环酸组的输血量和输血人数同样低于对照组(P<0.001);置换后血红蛋白值氨甲环酸组明显高于对照组(P<0.001)。置换后3 h两组的凝血指标差异无显著性意义;但两组D-二聚体均明显高于置换前,氨甲环酸组低于对照组,差异有显著性意义(P<0.001)。两组患者置换后均未发现下肢深静脉血栓形成。提示氨甲环酸能够有效减少全膝关节置换后的失血量、降低输血率和输血量,且不增加置换后深静脉血栓形成的风险。
BACKGROUND： Total knee arthroplasty is always associated with peripheral blood loss. Blood transfusion not only involves additional cost and prolongs rehabilitation time, but also carries substantial risk of immunologic reaction and disease transmission. Therefore it is very important to reduce blood loss of total knee arthroplasty. OBJECTIVE： To investigate the efficacy and safety of tranexamic acid on reducing blood loss after total knee arthroplasty. METHODS： We enrolled 64 patients with primary osteoarthritis undergoing a unilateral total knee arthroplasty and randomized them into two groups, with 32 patients in each group. Tranexamic acid group： patients received intravenous drop infusion of tranexamic acid dissolved in 250 mL normal saline （10 mg/kg） at 15 minutes before operation; control group： patients just received 250 mL normal saline. Intraoperative blood loss, postoperative blood loss, postoperative hemoglobin levels, amount of blood transfusion, and number of patients requiring blood transfusion were compared. Fibrinogen, prothrombin time and other coagulation indicators were also examined before operation and 3 hours after operation. Deep vein thrombosis in both limbs of all patients was examined by the color Doppler ultrasonography 30 days after operation. RESULTS AND CONCLUSION： There was no significant difference in intraoperative blood loss between the two groups （P 〉 0.05）. Postoperative volume of blood loss was lower in the tranexamic acid group than in the control group （P 〈 0.001）. The amount of blood transfusion and number of patients requiring blood transfusion were lower in the tranexamic acid group than in the control group （P 〈 0.001 ）. The postoperative hemoglobin levels were obviously higher in the tranexamic acid group than in the control group （P 〈 0.001）. There was no significant difference in coagulation indicators between two groups at postoperative 3 hours, but D-dimer value in the two groups was significantly higher than that before surgery, and the tranexamic acid group was lower than the control group （P 〈 0.001 ）. No cases appeared deep vein thrombosis after operation. Experimental findings indicate that, tranexamic acid can effectively reduce postoperative blood loss and blood transfusion, as well as number of blood transfusions after total knee arthroplasty. And it did not increase the risk of deep vein thrombosis.
出处
《中国组织工程研究》
CAS
北大核心
2015年第17期2655-2660,共6页
Chinese Journal of Tissue Engineering Research
作者简介
闵鹏，男，1977年生，黑龙江省哈尔滨市人，汉族，2001年黑龙江中医药大学毕业，主治医师，主要从事关节与创伤骨科研究。通讯作者：闵鹏，主治医师，成都市第一人民医院，四川省成都市610041
