不同氨甲环酸给药途径对全膝关节置换术出血量影响的临床研究

Application of tranexamic acid reduces blood less in unilateral total knee arthroplasty with different methods:aprospective comparison analysis

目的 探讨单侧全膝关节置换（TKA）术中应用氨甲环酸的不同给药方法对出血量的影响。方法 对2013年6月至2014年5月符合标准的120例初次单侧TKA术患者进行研究。其中男33例,女97例;年龄31-81岁,平均（65±9）岁。将患者分为静脉使用氨甲环酸组（V组）、局部使用氨甲环酸组（T组）、冲洗液使用氨甲环酸组（I组）以及未使用氨甲环酸组（L组）,每组30例。4组患者的年龄、性别、体质量指数、疾病诊断、手术时间、术前血红蛋白、术前红细胞比积等参数差异均无统计学意义（P〉0.05）。记录术后失红细胞量和输红细胞量,观察患者是否出现下肢深静脉栓塞症状。组间比较采用单因素方差分析。结果 V组总红细胞丢失量为（368±95）mL,T组（407±118）mL,少于对照组（509±96）mL,差异有统计学意义（P〈0.05）。I组总红细胞丢失量为（491±122）mL,与C组比较差异无统计学意义（P=0.924）。V组隐性失血量最少,T组可见失血量最少。4组均未出现深静脉栓塞、感染等并发症。结论 TKA术中静脉和局部使用氨甲环酸均能明显减少术后出血量。冲洗液中加入氨甲环酸不能有效减少出血量。

Objective To investigate the effect of the application of tranexamic acid in unilateral total knee arthroplasty （TKA）with different methods. Methods Totally 120 cases of primary unilateral TKA patients admitted from June 2013 to May 2012 were studied, including 33 males and 97 females, with the average age of （65±9） years （31 to 81 years）. Patients were divided into intravenous tranexamic acid group （group V）,topical tranexamic acid group （group T） and irrigation using tranexamie acid group （group 1） ,and control group （group C）. There were 30 cases in each group. Four groups of patients had no differences in age, gender, body mass index and disease diagnosis,operative time, preoperative hemoglobin, preoperative hematocrit differences statistically（P〉0.05）. Postoperative blood loss and blood transfusion were observed. Groups were compared using one-way ANOVA analysis. Results The total blood loss of group V was （368 ± 95）mL, total blood loss of group T was （407 ± 118）mL, both were less than the control group （509±96）mL,the difference was statistically significant（P〈0. 05）. The differences between the blood loss of group I （491± 122） mL and the control group was not statistically significant （P=0. 924）. Group V showed the least amount of hidden blood loss. Group T showed the least amount of visible blood loss. There were not deep vein thrombosis,infections and other complications in any groups. Conehtsion Intravenous and topical application of tranexamic acid can significantly reduce postoperative btood loss in TKA. Irrigation with tranexamic acid can not reduce the blood loss effectively.