小剂量氨甲环酸对全膝关节置换术后出血的临床研究

Effect of small dose tranexamic acid on postoperative blood loss of total knee arthroplasty

目的探讨小剂量氨甲环酸对全膝关节置换(TKA)术后出血的影响。方法选取2012年12月至2013年12月100例全膝关节置换患者为研究对象,其中男45例,女55例,平均年龄70.12岁;骨性关节炎90例,类风湿性关节炎5例,痛风性关节炎1例,创伤性关节炎4例。随机分成A、B两组(n=50),A组在松止血带时将10 ml氨甲环酸稀释于250 ml生理盐水中静脉滴注,B组以相同量的生理盐水作参照;两组术后12 h均开始每日皮下注射4100 U低分子肝素钙至出院。分别监测两组术后的总失血量、总输血量及输血例数,两组术前及术后第7天的D-二聚体及凝血酶原时间,并监测术后是否出现双下肢深静脉血栓。结果 A、B两组术后总失血量分别为(540±148)ml、(1102±229)ml,差异有统计学意义(P<0.05);两组术后总输血量分别为(531±166)ml、(1033±231)ml,差异有统计学意义(P<0.05),两组总输血例数分别为12例、36例,差异有统计学意义(P<0.05);A、B两组术后第7天D-二聚体分别为(0.71±0.49)mg/L、(1.41±0.52)mg/L,与术前的(0.34±0.11)mg/L、(0.35±0.09)mg/L相比明显升高,且B组高于A组,组间差异有统计学意义(P<0.05);两组术后第7天凝血酶原时间分别为(12.11±1.29)s、(12.32±1.21)s,与术前的(12.41±1.32)s、(12.49±1.23)s相比,差异未见统计学意义(P>0.05);两组术后监测均无双下肢深静脉血栓形成。结论小剂量氨甲环酸的应用可减少TKA术后出血量,减少临床用血,且与抗凝治疗不相矛盾。

Objective To investigate the effect of small dose tranexamic acid on postoperative blood loss total knee arthro- plasty （TKA）. Methods One hundred patients underwent TKA from December 2012 to December 2013 were chosen as research objects. Among the 100 patients, 45 cases were males and 55 cases were females, averaged 70. 12 years old. Ninty cases had os- teoarthritis, 5 cases had rheumatoid arthritis, 1 case had gouty arthritis and 4 cases had traumatic arthritis. These patients were randomized divided into group A and group B, with 50 patients in each group. In group A, 10 ml of tranexamic acid dissolved in 250 ml of normal saline was intravenously infused before deflation of the tourniquet. In group B, 250 ml of normal saline was in- fused intravenously. At 12 hours after operation, all patients received hypodermic injection with low-molecular-weight heparin. The amounts of blood loss and blood transfusion after operation were recorded. D-dimeride and prothrombin time before operation and at the 7 th after operation were also examined to assess whether they had deep vein thrombosis. Results The total blood loss was （540 ± 148） ml in group A and （ 1102 ±229） ml in group B, and the differences between the two groups were significant （P 〈 0. 05 ）. The averaged amount of blood transfusion was （531 ± 166）ml in group A and （1033 ± 231 ）ml in group B; there was significant difference between the two groups（P 〈0. 05 ）. The number of blood transfusion was 12 cases in group A and 36 cases in group B; there was significant difference between the two groups （P 〈 O. 05 ）. The level of D-dimeride was significantly higher 7 days after operation than before the operation, with （ 0. 92 ± 0. 56 ） mg/L and （ 0. 35 ± 0. 13 ） mg/L in group A, （1.32 ±0. 79） mg/L and （0. 37 ±0. 21 ） mg/L in group B. The D-dimeride level at 7 days after operation was significantly higher in group B than group A（P 〈0. 05 ）. There were no significant differences in the levels of prothrombin time（P 〉0.05 ）. No deep vein thrombosis was found in both lower limbs of the patients. Conclusion Small dose use of tranexamie acid can de- crease blood loss and blood transfusion, and has no conflict with anticoagulant therapy.