氨甲环酸在全膝关节置换术中局部应用和静脉应用的止血效果比较

Hemostatic effect of local application and intravenous application of tranexamic acid in total knee arthroplasty

目的比较氨甲环酸局部应用和静脉应用在减少全膝关节置换术患者出血量方面的效果和安全性。方法选择2012年6月至2013年12月符合标准的行初次单侧全膝关节置换术的100例患者。局部应用氨甲环酸术中止血的47例患者作为A组,静脉使用氨甲环酸术中止血的53例患者作为B组。分别记录两组术中出血量、术后失血量、输血例数、输血量、术后第1、3、5天血红蛋白值、红细胞压积、术前和术后3 h纤维蛋白原、凝血酶原时间、活化的部分凝血酶原时间、D-二聚体,术后5~7 d双下肢静脉超声筛查有无深静脉血栓（DVT）。结果 A组术后引流量、总失血量、输血量少于B组,未输血患者术后1、3、5 d血红蛋白值高于B组,差异有统计学意义（P〈0.05）;两组患者术前和术后3 h纤维蛋白原、凝血酶原时间、活化的部分凝血酶原时间、D-二聚体比较差异无统计学意义（P〉0.05）;术后经双下肢静脉超声检查均未见下肢深静脉血栓,术后随访均无下肢深静脉栓塞和肺栓塞。结论全膝关节置换术中局部应用氨甲环酸和静脉应用比较能明显减少术后出血量、降低输血量,二者均不增加DVT形成的风险。

Objective To compare the efficacy and safety of tranexamic acid local use and intravenous use in reducing blood loss of patients who received total knee arthroplasty（ TKA）. Methods A hundred patients who received primary unilateral TKA from June 2012 to December 2013 were analyzed retrospectively. Patients in group A（ n = 47） received local application of tranexamic acid,and patients in group B（ n = 53） were given tranexamic acid intravenously. The amounts of intraoperative blood loss,postoperative visible blood loss,the number of patients needed blood transfusion,blood transfusion volume,hemoglobin at 1,3,5 d after operation,hematocrit,preoperative and postoperative 3 h fibrinogen,PT,APTT,D-dimer were recorded respectively. The low er limbs venous ultrasound was used to screen for patients with DVT at 5 ~ 7 d after operation. Results The postoperative suction drainage,total blood loss and blood transfusion volume of group A were low er than those of group B（ P〈0. 05）,and the levels of hemoglobin at 1,3,5 d after operation in patients without blood transfusion in group A were significantly higher than those of group B（ P〈0. 05）. There was no significant difference in preoperative and postoperative 3 h fibrinogen,PT,APTT,D-dimer between the tw o groups（ P〉0. 05）. Conclusion Compared with intravenous application,the intraoperative local use of tranexamic acid could significantly reduce the amounts of postoperative blood loss,low er blood transfusion volume of TKA patients,and both the tw o kinds of medication methods do not increase the risk of DVT.