持续阿司匹林抗凝对髋膝关节置换出血量的影响

Continuous aspirin anticoagulation affects blood loss during total knee and hip arthroplasties

背景:进行髋膝置换前使用阿司匹林抗凝预防心脑血管疾患的患者很多见,而目前国内尚无髋膝关节置换患者围置换期持续应用阿司匹林对于出血量影响的报道。目的:观察围置换期持续应用小剂量阿司匹林抗凝对于髋膝关节置换出血的影响。方法:天津市第一中心医院骨科2012年12月至2013年8月收治初次髋膝关节置换患者40例,根据抗凝方案分为两组,每组20例。观察组置换前长期连续规律应用100 mg/d阿司匹林抗凝,除置换日之外不停药。对照组未使用阿司匹林抗凝,与观察组患者年龄相近,与观察组为同一手术医师。两组中全髋关节置换10例,全膝关节置换10例。置换过程中积极止血,置换后采用加压冰敷等减少出血措施。记录置换后48 h伤口引流量、围置换期血红蛋白变化及并发症发生率,随访3个月观察关节功能恢复情况。结果与结论:两组之间置换前及置换后的血红蛋白变化水平、置换后48 h伤口引流量、围手术期血红蛋白变化、并发症发生率以及随访3个月的关节功能评分差异均无显著性意义。提示积极采取减少出血的措施,围置换期持续应用小剂量阿司匹林抗凝对于初次髋膝关节置换出血无明显影响,可以安全使用。

BACKGROUND：Many patients underwent aspirin anticoagulation in preventing cardiovascular disease before hip and knee replacement.No report addressed the effect of aspirin on blood loss during perioperative stage in patients receiving hip and knee replacement.OBJECTIVE：To observe the effect of perioperative continuous low-dose aspirin anticoagulation application on total hip arthroplasty or total knee arthroplasty.METHODS：A total of 40 patients with primary total hip arthroplasty or total knee arthroplasty were enrolled in the Department of Orthopedics,Tianjin First Center Hospital from December 2012 to August 2013.According to anticoagulation scheme,they were divided into two groups（n=20）.In the observation group,100 mg/d aspirin anticoagulation was continuously used before replacement for a long period,and the medicine was not withdrawn except the day of replacement.In the control group,aspirin anticoagulation was not used,and their ages were similar to the observation group.The operation was conducted by the same physician in the observation and control groups.10 patients received total hip arthroplasty and 10 patients received total knee arthroplasty in bothgroups.Bleeding was stopped actively during replacement.After replacement,pressurized ice compress was used to reduce bleeding.At 48 hours after replacement,wound drainage,perioperative hemoglobin and the incidence of complications were recorded.Joint function recovery was observed at 3 months of follow-up.RESULTS AND CONCLUSION：Hemoglobin levels before and after operation,postoperative blood drainage at 48 hours,perioperative hemoglobin changes,the incidence of complication,and joint function score at 3-month follow-up did not show significant difference between both groups.These findings indicate that it is safe to use some measures for reducing blood loss and continue low-dose aspirin in the perioperative period.The use of aspirin did not impact blood loss.