局部注入氨甲环酸对40例首次单侧全髋关节置换术后失血量的影响

Effects of topical injection of tranexamic acid on the postoperative blood loss in 40 cases of unilateral total hip arthroplasty

[背景]探讨局部注射给予氨甲环酸并夹闭引流管4h对首次行单侧全髋关节置换术（THA）后总失血量的影响.[病例报告]取符合纳入标准的患者80例,给施行单侧THA,术后术区内留置1根引流管,氨甲环酸组40例向术区内局部注射给予氨甲环酸50mL,对照组40例注射给予等量生理盐水,夹闭引流管4h后进行负压吸引.术后3d内每日复查血常规及凝血功能;分别记录术后8,12,24h引流量及输血人数,计算隐性失血量;术后3-5d行双下肢动静脉超声波检查.氨甲环酸组术后3d的总引流量、隐性失血量、总失血量及输血人数均明显少于对照组（P〈0.01）;两组在血栓形成、术后凝血功能及不良反应方面差异均无统计学意义（P〉0.05）.[讨论]局部注射给予氨甲环酸并夹闭引流管4h可有效减少首次行单侧THA后总失血量及隐性失血量,且不增加血栓发生率.

BACAKGROUNDTo study the effects of topical injection of tranexamic acid（TXA）and keep for 4hours with clipping drainage tube on the postoperative total blood loss at unilateral total hip arthroplasty（THA）.CASE REPORTS80 patients with primary unilateral THA in accordance with the inclusive criteria were randomly divided into two groups,and were indwelled a drainage tube at the end of THA.The 40 patients in TXA group were injected with 50 mL TXA into operation areas,while the other in control group with an equal volume of normal saline.After the injection,the drainage tube was clamped for 4h and performednegative pressure drainage.Each patient was received the daily routine examination and blood coagulation indicator test at 3days.The postoperative drainage volume at 8,12 and 24h,hidden blood loss volume and the number of patients accepted blood transfusion were recorded,and the arteriovenous doppler ultrasound examination of lower limbs were administrated at 3-5days after the operation.The postoperative total drainage,hidden blood loss,total blood loss and transfusion number were significantly less in the TXA group than in the control group（P〈0.01）,and there were no significant differences between two groups in thrombosis,blood coagulation indicator test and adverse reactions.DISCUSSION The topical injection of TXA and keep for 4hours with clipping drainage tube in the unilateral THA can effectively reduce the postoperative blood loss and hidden blood loss without increasing the incidence of thrombosis.