人工全膝关节置换术中使用氨甲环酸的疗效研究

EFFECTIVENESS OF TRANEXAMIC ACID IN TOTAL KNEE ARTHROPLASTY

目的探讨人工全膝关节置换术(total knee arthroplasty,TKA)中使用氨甲环酸的安全性和有效性。方法选择2012年5月-2013年5月收治的88例(88膝)拟行初次TKA且符合选择标准的退行性骨关节炎患者作为研究对象,根据TKA术中是否使用氨甲环酸(15 mg/kg),随机分为试验组和对照组(n=44)。排除11例失访患者,试验组39例、对照组38例纳入最终分析。两组患者性别、年龄、病程、身体质量指数、骨关节炎分级及术前实验室检查等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者术中止血带使用时间、术中失血量、术后24 h引流量、总引流量、隐性失血量、总失血量、术后3 d血红蛋白、术后24 h D-二聚体,以及术后下肢瘀斑、下肢深静脉血栓形成及输血情况。结果两组术中止血带使用时间及术中失血量比较,差异无统计学意义(P>0.05)。试验组术后24 h引流量、总引流量、隐性失血量、总失血量、术后24 h D-二聚体均明显低于对照组(P<0.05),术后3 d血红蛋白明显高于对照组(t=4.815,P=0.000)。术后试验组和对照组分别有3例(7.7%)和4例(10.5%)患者输血,各发现3例(7.7%、7.9%)无症状性下肢深静脉血栓形成,组间比较差异均无统计学意义(P>0.05)。试验组及对照组分别有1例(2.6%)和7例(18.4%)发生下肢瘀斑,差异有统计学意义(χ2=0.029,P=0.026)。结论 TKA术中静脉给予氨甲环酸能显著减少围手术期失血量,且不增加下肢深静脉血栓形成的风险。

Objective To investigate the safety and effectiveness of using tranexamic acid in total knee arthroplasty （TKA）. Methods Between May 2012 and May 2013, 88 patients （88 knees） with degenerative osteoarthritis underwent primary TKA and were divided into 2 groups （n=44） according to whether use of tranexamic acid （15 mg/kg） or not. Seventy-seven patients （39 in trial group and 38 in control group） were enrolled in this study except 11 patients who failed to be followed up.There was no significant difference in gender, age, disease duration, body mass index, osteoarthritis grading, and preoperative general data of laboratory examination between 2 groups （P〉0.05）. The following indexes were recorded and compared between 2 groups： intraoperative tourniquet time, intraoperative blood loss, postoperative drainage volume during 24 hours, total drainage volume, hidden blood loss, total blood loss, the number of transfusion, postoperative haemoglobin （Hb） at 3 days, postoperative D-dimer at 24 hours, ecchymosis, and deep venous thrombosis （DVT）. Results No statistically significant difference was found in intraoperative tourniquet time and intraoperative blood loss between 2 groups （P〉0.05）. The postoperative drainage volume during 24 hours, total drainage volume, hidden blood loss, total blood loss, and postoperative D-dimer at 24 hours in trial group were significantly lower than those in control group （P〉0.05）. The postoperative Hb at 3 days in trial group was significantly higher than that in control group （t=4.815, P=0.000）. Three cases （7.7%） of trial group and 4 cases （10.5%） of control group were given blood transfusion, showing no significant difference （P〉0.05）; DVT occurred in 3 cases of 2 groups repectively （7.7%, 7.9%）, showing no significant difference （P〉0.05）. Extremity ecchymosis occurred in 1 case （2.6%） of trial group and in 7 cases （18.4%） of control group, showing significant difference （χ^2=0.029, P=0.026）. Conclusion Use of tranexamic acid can significantly reduce blood loss and does not increase the risk of DVT after TKA.