氨甲环酸对减少初次行双侧全膝关节置换术患者围手术期失血的安全性及有效性研究

Efficacy and safety of tranexamic acid in treating perioperative blood loss in bilateral total knee arthroplasty(TKA)

目的观察氨甲环酸对初次同期行双侧全膝关节置换术(TKA)患者围手术期失血的有效性及安全性。方法选取在新疆医科大学第一附属医院关节外科2013年4月-2014年4月同期行双侧TKA的206例患者。随机分为两组,试验组103例、对照组103例,试验组在第2条膝关节TKA术毕松止血带之前将氨甲环酸1g稀释于250mL生理盐水后静点完毕;对照组在相同时间将250mL生理盐水静点完毕。比较两组围手术期失血量、输血量及并发症情况。结果试验组和对照组术中出血量、术中输血量差异无统计学意义(P>0.05);两组术后输血量分别为(117.48±214.40)mL和(357.38±325.08)mL,差异有统计学意义(P<0.05)。围手术期总失血量分别为(1 628.10±570.32)mL和(2 120.11±529.20)mL,差异有统计学意义(P<0.05)。试验组出现皮下瘀斑患者41例(39.81%),对照组76例(73.79%),两组差异有统计学意义(χ2=22.87,P<0.001)。两组术前、术后3h凝血功能比较差异无统计学意义(P>0.05)。两组患者术后第5天及术后1个月复查双下肢血管B超,未见深静脉血栓(DVT)形成。结论初次同期行双侧TKA手术中于第2条膝关节TKA术毕松止血带之前静脉给予TXA能明显减少围手术期失血量及输血量,降低输血风险及输血费用,明显减少双下肢瘀斑发生率及瘀斑面积,利于术后功能恢复,且不增加下肢深静脉血栓(DVT)形成及肺栓塞(PE)的风险。

Objective To investigate the efficacy and safety of tranexamic acid in treating perioperative blood loss in patients who received bilateral TKA.Methods From April 2013 to April 2014,206 patients from Joint Surgery of The First Affiliated Hospital of Xinjiang Medical University underwent primary bi-lateral TKA and they were randomly divided into group A and group B with 103 cases in each group.The patients in treatment group received 1g of TXA dissolved in 250 ml of normal saline by fast intravenous in-fusion before the end of the second knee operation,and patients in control group received an equal volume of normal saline at the same time.We compared data from two groups in terms of perioperative blood loss, blood transfusion and complication.Group t test was used to compare the data.Results There were no sig-nificant differences in intraoperative blood loss and transfusion （P 〉0.05）.The amount of postoperativeblood transfusion of both groups were （117.48±214.40）mL and （357.38±325.08）mL,which was signifi-cantly different （P〈0.05）.Total perioperative blood loss in both groups were（1 628.10±570.32）mL and （2 120.11±529.20）mL,which was also significantly different （P〈0.05）.The cases of subcutaneous ec-chymosis in both groups were 41 （39.81%）and 76 （73.79%）（χ2 =22.87,P〈0.001）.There was not sta-tistically significant difference in the coagulation indicators between preoperative and postoperative.No deep venous thrombosis was observed through Doppler ultrasound examination after 6 days and 1 mouth. Conclusion The intravenous infusion of tranexamic acid intraoperatively in primary bilateral TKA patients could significantly reduce the amount of perioperative blood loss and blood transfusion,hence the risk of blood transfusion and transfusion cost.The incidence of ecchymosis and the area of ecchymosis can be cut down signifi-cantly,which is good to patients′recovery from the operation and decrease the risk of DVT and PE.