全膝关节置换术应用不同剂量氨甲环酸有效性的研究

Effectiveness of Different Dosages of Tranexamic Acid in Application of Total Knee Arthroplasty

目的探讨单侧初次全膝关节置换术中给予不同剂量氨甲环酸的有效性。方法 2014年1—9月之间拟行初次单侧人工全膝关节置换术的骨关节炎90例,随机分为3组,每组30例:关闭切口前静脉滴注生理盐水(A组);关闭切口前静脉滴注氨甲环酸10 mg/kg(B组);关闭切口前静脉滴注氨甲环酸15 mg/kg(C组)。比较3组的术后24 h引流量、总失血量、显性失血量、隐性失血量、输血率、术后深静脉血栓和肺栓塞发生率。结果 3组手术时间和术中出血量、输血率的差异无统计学意义(P>0.05)。B、C组术后引流量明显低于A组(P<0.05),B、C组术后血红蛋白水平均高于A组(P<0.05),B、C组的总失血量、显性失血量低于A组(P<0.05),C组隐性失血量显著低于A、B组(P<0.05)。3组术后均无深静脉血栓及肺梗死发生。结论全膝关节置换术中闭合切口前静滴氨甲环酸能有效减少术后引流量、总失血量、显性失血量,提高术后血红蛋白水平,静滴15 mg/kg的氨甲环酸能进一步减少隐性失血。

Objective To explore the effectiveness of different dosages of Tranexamic Acid（ TXA） in application of unilateral primary total knee arthroplasty（ TKA）. Methods A total of 90 patients with knee osteoarthritis,undergoing unilateral primary TKA from January to September 2014 were randomly divided into three groups（ n = 30 for each group）. Patients in group A received physiological saline via fast intravenous infusion before closing the incision;patients in group B received 10 mg / kg TXA via fast intravenous infusion before closing the incision; patients in group C received 15 mg / kg TXA via fast intravenous infusion before closing the incision. The draining volume within postoperative24 h,total blood loss,external blood loss,hidden blood loss,transfusion rate and incidence rates of postoperative deep vein thrombosis rate and pulmonary embolism were compared in the three groups. Results There were no significant differences in operation time,intraoperative bleeding volume and transfusion rate in the three groups（ P〈0. 05）. Compared with those in group A,postoperative draining volumes were significantly reduced（ P〈0. 05）,and postoperative hemoglobin levels were significantly increased（ P〈0. 05）,and the values of total blood loss and external blood loss were significantly decreased in group B and C（ P〈0. 05）. The value of hidden blood loss in group C was significantly decreased compared with those in group A and B（ P〈0. 05）. No postoperative deep vein thrombosis or pulmonary embolism was found in the three groups. Conclusion TXA intravenous infusion before closing the incision in application of TKA can effectively reduce the volumes of postoperative draining volume,total blood loss and external blood loss and increase the postoperative hemoglobin level,and 15 mg / kg of TXA intravenous infusion is more effective in reducing hidden blood loss.