氨甲环酸减少全髋关节翻修术围手术期失血的安全性及有效性研究

Pilot study of tranexamic acid reducing blood loss in perioperative period of revision total hip arthroplasty

目的探讨氨甲环酸减少全髋关节翻修术围手术期失血的有效性及安全性。方法将60例拟行单侧全髋关节翻修手术的患者随机分为氨甲环酸组与对照组,每组30例。术前所有患者均进行血常规、凝血常规、双下肢静脉彩超等检查,氨甲环酸组患者于切皮前10 min静脉单次使用10 mg/kg的氨甲环酸,对照组予以相当剂量的生理盐水。记录术中出血量、术后引流量,术后第1天、第3天复查血常规并记录患者血红蛋白水平和红细胞压积,术后第5天复查双下肢静脉彩超。如患者术后血红蛋白水平低于80 g/L或患者有贫血表现时予以输入同型红细胞悬液。通过公式计算并比较患者血容量、总失血量、隐性失血量等指标。记录患者术后输血量和深静脉血栓的发生率。结果氨甲环酸组患者术中出血、术后引流、总失血量及隐形失血量均低于对照组,差异有统计学意义。氨甲环酸组患者术后14例(46.7%,14/30),对照组26例(86.7%,26/30)需要输血,差异有统计学意义。两组患者术后深静脉血栓发生率及术后住院日比较差异无统计学意义。结论以10 mg/kg氨甲环酸术前静脉单次用药为主的多模式控制血液丢失方案可以有效减少髋关节翻修手术围手术期的血液丢失且不增加下肢深静脉血栓和肺栓塞的发生风险,该方案是髋关节翻修术围手术期控制血液丢失的安全、有效的方法。

Objective To evaluate the efficacy and safety of using tranexamic acid to reduce the blood loss in patients who undergo revision total hip arthroplasty during the perioperation period. Methods 60 patients who were scheduled to undergo revision total hip arthroplasty were randomized divided into two groups ： the tranexamic group （TXA group, n = 30） and the control group （ n = 30）. All the patients had blood routine examination, coagulation routine examination and the color Doppler flow imaging of the lower limbs. The TXA group were intravenously given tranexamic acid 10 mg/kg 10 minutes before the surgery, while the control group were given equivalent saline for instead. The blood loss during the operation and the drainage volume were recorded, the blood routine examination was taken on the 1st and the 3rd days postoperatively. All the patients were re-examined the color Doppler flow imaging of the lower limbs five days after the operation. The patient would be given two units red cell suspension if the haemoglobin was lower than 80 g/L. The Cross equation was used to figure out the patients blood volume, the total and hidden blood loss. The rate of blood transfusion and deep vein thrombosis were also recorded. Results In the TXA group, the blood loss during the operation, the drainage volume, the total and hidden blood loss were all less than those in the control group. The difference had statistical significance. There were 14patients in the TXA group and 26 patients in the control group needing blood transfusion. No venous thrombosis was found in this study. The incidence of deep venous thrombosis and the length of hospital stay of the two groups had no statistically significant differences. Conclusion A single intravenous use of TXA （ 10 mg/kg） before operation can significantly reduce the blood loss without increasing the risk of deep-vein thrombosis and pulmonary embolism in the perioperative period of revision total hip arthroplasty, which is an efficacy and safety way to reduce the blood loss