氨甲环酸减少同期双侧全髋置换围术期失血有效性及安全性研究

A study of the efficacy and safety of tranexamic acid in the reduction of perioperative bleeding during simultaneous bilateral primary total hip replacement

[目的]探讨静脉10 mg／kg氨甲环酸减少同期双侧全髋关节置换术（total hip arthroplasty，THA）围术期失血的有效性及安全性。[方法]回顾四川大学华西医院2011年7月～2013年7月所有同期双侧全髋关节置换术，设定纳入排除标准后共纳入57例。其中静脉使用10 mg／kg氨甲环酸3l例，未使用26例。氨甲环酸组患者于每侧手术切皮前均完成静脉单次使用10 mg／kg氨甲环酸，对照组不使用。对比术前及术后不同时间点血红蛋白（HB）值及红细胞压积（HCT）值的差异；根据Gross方程计算围术期总失血量；统计两组输血量及输血率；根据术后第5d双下肢静脉彩超结果判断术后深静脉血栓及肌间静脉血栓发生率，统计肺栓塞的发生率及术后住院天数，应用SPSS统计软件得出结论。[结果]氨甲环酸组术后1、3 d HB值及HCT值明显高于对照组，P〈0．05，差异有统计学意义，但术后第5 d差异无统计学意义。氨甲环酸组围术期平均失血（1 811．6±490．8）ml，明显低于对照组（2 408．6±511．3）ml，P〈0．05，差异有统计学意义。氨甲环酸组患者术后8例（25．8％，8／31），对照组14例（53．8％，14／26）输血，P〈0．05，差异有统计学意义。氨甲环酸组人均输血量0．68 U，明显低于对照组1．23 U，P〈0．05，差异有统计学意义。两组患者术后深静脉血栓、肌间静脉血栓、肺栓塞发生率及术后平均住院日比较差异无统计学意义。[结论]静脉单次10 mg／kg氨甲环酸于每侧关节置换前单次用药是控制同期双侧THA围术期失血安全、有效的方法。

[Objective]To investigate the efficacy and safety of a single - dose of 10 mg/kg intravenous tranexamic acid inthe reduction of perioperative bleeding during simultaneous bilateral primary total hip arthroplasty （THA）. [ Method ] We retrospectively reviewed patients who underwent surgery from July 2011 to July 2013. The final sample comprised 57 patients ,31 ofwhom had received a single dose of 10 mg/kg intravenous tranexamic acid. We compared the preoperative and postoperative HBand HCT at different time points, and calculated the perioperative blood loss according to the Gross equation, the rate of transfu-sion was also compared between the two groups. Furthermore, based on the results of a double venous ultrasound performed onpostoperative day 5, we obtained the incidence of deep vein thrombosis and pulmonary embolism （PE）. The mean postoperativein -patient days were also analyzed using the SPSS statistical software. [ Result] The HB and HCT on postoperative days 1 and3 were significantly higher in the tranexamic acid group than in the control group （ P 〈 0.05 ）, however, the results showed nosignificant difference on postoperative day 5. The total blood loss in the tranexamic acid group was significantly lower than that inthe control group （ 1 811.6 ＋490.8 vs. 2 408.6 ＋511.3 ml,P 〈0.05）. Eight patients in the tranexamic acid group （25.8%）and 14 patients in the control group （53.8%） needed a blood transfusion （P 〈0.05） ,the difference between the groups wasstatistically significant. The postoperative incidence of VTE and PE, and the postoperative in - patient days were not significantlydifferent between the groups. [ Conclusion ] Administration of a single preoperative dose of 10 mg/kg intravenous tranexamicacid is a safe and effective method for reducing perioperative blood loss during simultaneous bilateral primary THA.