氨甲环酸减少全膝关节置换术失血量的有效性和安全性评价

Efficacy and safety of tranexamic acid on perioperative blood loss inEfficacy in total knee arthroplastytotal arthroplasty

背景背景:全膝关节置换术(TKA)后出血的重要原因是止血带效应所导致的纤溶亢进,通过使用抗纤溶药物氨甲环酸(TXA)减少出血量越来越受到重视。目的目的:探讨TXA减少TKA失血量的有效性和安全性。方法方法:2012年3月至2012年9月选择130例行初次TKA的患者,随机分为两组,每组65例。A组为试验组,安放完假体关闭切口前静脉给予10 mg/kg TXA;B组为对照组,不给予TXA。比较两组患者术后6 h内每小时引流量、总引流量、术后不同时间点血红蛋白、总失血量、输血人数、凝血酶原时间(PT)、活化部分凝血酶原时间(APPT)、纤维蛋白原(FIB)、D-二聚体和深静脉血栓(DVT)发生率。结果结果:术后1~3 h每小时引流量和总引流量A组少于B组(P【0.05),术后4~6 h每小时引流量A组少于B组(P【0.05)。术后1 d、3 d、5 d A组血红蛋白值均高于B组(P【0.05)。A、B两组总失血量分别为752 ml和1107 ml(P【0.05)。A、B两组输血人数分别为5人和12人,输血率分别为7.7%和18.5%(P【0.05)。两组患者术前、松止血带时、术后3 h和术后24 h PT、APTT、FIB差异无统计学意义(P】0.05)。两组患者术后3 h和24 h D-二聚体均升高,组间比较差异有统计学意义(P【0.05)。术后5 d两组患者静脉彩色多普勒超声检查均未见DVT,术后3周两组患者均未发现症状性DVT。结论结论:TKA手术中安放完假体关闭切口前按10 mg/kg静脉给予TXA是安全有效的。

Background:Fibrinolysis is stimulated by surgical trauma and further augmented by the use of a tourniquet in total knee ar-throplasty (TKA). Tranexamic acid (TXA) inhibits fibrinolysis by blocking the lysine-binding sites of plasminogen to fibrin. TXA has been recommended recently to decrease blood loss after TKA. <br> Objective:To explore the effectiveness and safety of TXA in reducing blood loss after TKA. <br> Methods: From March 2012 to September 2012, 130 patients underwent unilateral TKA and were randomly divided into group A and group B with 65 cases in each group. The patients in group A received 10mg/kg TXA by fast intravenous infu-sion at the end of the operation, while the patients in group B did not receive TXA as a control group. The postoperative wound drainage, hemoglobin level, total blood loss, the number of patients inquring blood transfusion were recorded and compared between the two groups. Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) and D-Dimer were measured before TKA, on deflation of the tourniquet, 3 hours after TKA, and 24 hours after TKA. Deep vein thrombosis (DVT) were observed by the color Doppler ultrasonography after TKA. <br> Results:The mean drainage in the first three hours and the total drainage in group A were significantly less than those in group B (P<0.05). The total blood loss in group A was significantly less than that in group B (752 ml vs 1107 ml, P<0.05). The hemo-globin concentration in group A was significantly higher than that in group B on day 1, 3 and 5 after TKA (P<0.05). The pa-tients needing blood transfusion in group A was significantly less than that in group B (5 cases versus 7 cases, P<0.05). There were no significant differences in the levels of PT, APTT and FIB between the two groups (P>0.05). D-dimer was higher in 3 hours and 24 hours after TKA than preoperative ones in both groups, and there was significant difference in D-dimer between the two groups (P<0.05). No DVT occurred in both two groups. <br> Conclusion:Intravenous infusion of 10 mg/kg of TXA before the endof the operation is effective and safe in TKA.