氨甲环酸对类风湿关节炎患者全髋关节置换围手术期失血的影响

The efficacy and safety of tranexamic acid on bleeding in rheumatoid arthritis patients following total hip arthroplasty： a retrospective study

目的探索氨甲环酸对类风湿关节炎患者全髋关节置换围手术期失血的影响。方法回顾性分析2012年6月至2014年6月行初次全髋关节置换术患者资料，仅纳入因类风湿关节炎（Steinbrocker3、4级）行初次单侧全髋关节置换术患者数据，最终纳入197例。其中68例术前20min静脉滴注氨甲环酸15mg/kg（单次给药组），74例术前20min静脉滴注氨甲环酸15mg/kg＋术后3h再次静脉滴注氨甲环酸10mg／kg（重复给药组），55例未使用氨甲环酸（对照组）。单次给药组女52例、男16例，平均年龄58岁；重复给药组女54例、男20例，平均年龄59岁；对照组女40例、男15例，平均年龄55岁。比较三组患者总失血量、输血率、深静脉血栓及肺栓塞发生率、术后引流量、术后血红蛋白下降值及并发症情况。结果单次给药组、重复给药组和对照组围手术期总失血量分别为（816．80±245．09）ml、（975．15±216．33）ml和（1295．68±263．85）ml，术后引流量为（221．60±70．05）ml、（337．20±113．10）ml和（479．74~120．66）ml，输血率为5．41％、10．29％和25．45％，术后血红蛋白降低值为（2．71±0．74）g／dl、（3．18±0．62）g／dl和（3．83±0．70）g／dl；各指标给药组均较对照组低，重复给药组较单次给药组围手术期总失血量、输血率、术后引流量更低。术后三组患者均未发生深静脉血栓及肺栓塞；单次给药组8例、重复给药组6例、对照组8例出现切口并发症，发生率分别为11．8％（8／68）、8．1％（6／74）、14．5％（8／55），三者比较差异无统计学意义（r=1．355，P=0．508）。结论静脉使用氨甲环酸可有效降低类风湿关节炎患者全髋关节置换围手术期总失血量与输血率，且不增加血栓事件的风险，相对于术前单次使用氨甲环酸，更推荐术前及术后3h重复给药。

Objective To investigate the efficacy and safety of tranexamic acid on bleeding in rheumatoid arthritis （RA） patients undergoing total hip arthroplasty （THA）. Methods A retrospective study was performed in 197 RA patients （Steinbrocker Ⅲ-Ⅳ） following primary unilateral THA from June 2012 to June 2014. The patients were divided to three groups based on the regimen of tranexamic acid： 68 patients received a single intravenous dosage of 15 mg/kg tranexamic acid 20 min prior to operation （single dose group）; 74 patients received an intravenous dosage of 15 mg/kg preoperatively and a second dosage of 10 mg/kg 3 hours postoperatively （repeated dose group）; the other 55 patients didn＇t receive tranexamic acid （control group）. The primary outcomes were total blood loss, transfusion rate, the incidence of deep vein thrombosis （DVT） and pulmonary embolism （PE）. The secondary outcomes were postoperative drainage, hemoglobin （Hb） drop on third day postoperatively and other wound related complications. Results There was less total blood loss （816.80±245.09 ml vs 975.15±216.33 ml vs 1 295.68±263.85 ml）, drainage （221.60±70.05 ml vs 337.20± 113.10 ml vs 479.74± 120.66 ml）, transfusion requirement （5.41% vs 10.29% vs 25.45%） and Hb drop （2.71±0.74 g/dl vs 3.18±0.62 g/d1 vs 3.83±0.70 g/dl） in experimental group when compared with control group. And the effect was better in repeated dose group, with less total blood loss （816.80±245.09 ml）, less transfusion requirement （5.41%） and less postoperative drainage （221.60±70.05 ml）. No episode of DVT or PE occurred in either group. There were 8 wound complications in single dose group, 6 in repeated group, and 8 in control group, and there were no statistically difference. Conclusion Intrave- nous administration of tranexamic acid was effective and safe on decreasing blood loss and transfusion requirement in RA patients following THA. Compared with a single dosage of tranexamic acid preoperatively, a second dosage of tranexamic acid 3 hours post- operatively was recommended.