全膝关节置换围手术期氨甲环酸不同使用方法的有效性和安全性

Perioperative efficiency and safety of different regimen of tranexamic acid on total knee arthroplasty

目的 探讨在全膝关节置换围手术期氨甲环酸不同使用方法的有效性和安全性.方法 2013年2至5月150例行初次单侧全膝关节置换的女性骨关节炎患者随机分为三组,每组50例.分别在关闭切口前静脉滴注氨甲环酸10 mg/kg（单次使用组）;关闭切口前静脉滴注氨甲环酸10 mg/kg、术后3h再次按该剂量重复使用（重复使用组）;不使用氨甲环酸（对照组）.比较三组引流量、总失血量、隐性失血量、术后不同时间血红蛋白、输血患者比例、深静脉血栓和肺栓塞发生率.结果 对照组引流量（447.2±101.9） ml,大于单次使用组（273.6±99.6） ml和重复使用组（168.5±80.8） ml,差异有统计学意义.对照组总失血量（1 100.8±288.3） ml,大于单次使用组（959.1±291.7） ml和重复使用组（818.7±206.9） ml,差异有统计学意义.三组隐性失血量的差异无统计学意义.对照组术后第1、3、5天的血红蛋白均低于单次使用组和重复使用组,重复使用组均高于单次使用组,差异有统计学意义.三组输血患者比例分别为8.0％（4/50）、6.0％（3/50）和22.0％（11/50）,对照组高于单次使用组和重复使用组,差异有统计学意义.术后90 d内均未出现症状性深静脉血栓和肺栓塞.结论 全膝关节置换术中关闭切口前静脉滴注氨甲环酸10 mg/kg能有效减少围手术期失血量和降低输血患者比例,术后3h重复使用能进一步减少失血量,但不能进一步降低输血患者比例.使用氨甲环酸不增加深静脉血栓和肺栓塞发生的风险.

Objective To explore the perioperative efficiency and safety of different regimen of tranexamic acid （TXA） in total knee arthroplasty （TKA）.Methods From February 2013 to May 2013,150 female patients with knee osteoarthritis underwent unilateral TKA were randomly divided into three groups,50 cases in each group.Patients received 10 mg/kg TXA by fast intravenous infusion before closing the wound in first group （single dose group）,patients in second group received two doses of 10 mg/kg TXA before closing the wound and 3 hours postoperation （repeated dose group）,patients in the third group didn＇t receive TXA （control group）.The postoperative blood loss via drainage,the total blood loss,the hidden blood loss,the postoperative hemoglobin concentration at different times and the numher of patients need blood transfusion were recorded.All patients were observed for detecting deep vein thrombosis （DVT） by the color doppler ultrasonography within 5 days postoperation,and the symptomatic DVT and pulmonary embolism （PE） were observed within 90 days postoperation.Results The blood loss via drainage was significantly less in the single dose group （273.6±99.6 ml） and repeated dose group （168.5±80.8 ml） compared with the control group （447.2±101.9 ml）,and it was significantly less in the repeated dose group than the single dose group; the total blood loss was significantly less in the single dose group （959.1±291.7 ml） and repeated dose group （818.7±206.9 ml） compared with the control group （1 100.8±288.3 ml）,and it was significantly less in the repeated dose group than in the single dose group; there was no differ ences about the hidden blood loss among the three groups.The hemoglobin concentration was significantly higher in the single dose group and repeated dose group than in the control group in day 1,3 and 5 postoperation; and it was significantly higher in the repeated dose group compared with the single dose group.The ratio of transfusion was significantly less in the single and repeated dose groups than in the control group,but no differences exists between the single dose group and repeated dose group.There was no DVT in all of the three groups within 5 days postoperation,and there was no symptomatic DVT and PE in all of the three groups within 90 days.Conclusion 10 mg/kg of TXA infused intravenous before closing the wound is effective and safe in TKA,another dose 3 hours postoperation is much more effective and will not increase the danger of DVT and PE.