氨甲环酸关节内应用对全髋关节置换术后失血量的影响

Effect of intra- articular use of Tranexamic acid on blood loss after total hip replacement

目的探讨关节腔内应用氨甲环酸对全髋关节置换术后失血量的影响。方法选取80例拟行初次单侧全髋关节置换术患者，随机分为A、B两组，每组40例。A组在缝合关节囊后向关节腔内注射溶于50ml生理盐水的氨甲环酸1g；B组仅给予等量生理盐水关节腔内注射。记录术后失血量、输血量、输血例数、术后血红蛋白浓度和术后3小时纤维蛋白原、凝血酶原时间、活化部分凝血活酶时间等为评价指标。观察患者是否出现下肢深静脉栓塞的临床症状，并于术后7d及14d行下肢血管多普勒超声检查。结果A组和B组术后可见失血量（315±82ml；483±105m1）、输血量（240±35ml；482±124m1）和输血例数（8例；21例）比较差异有统计学意义（P=0．01，P〈0．05）；术后血红蛋白浓度，A组（95±12g／L）明显高于B组（76±15g／L）（P=0．01，P〈0．05）；两组患者术后3h纤维蛋白原（3．72±0．51g／L；3．69±0．64g／L1、凝血酶原时间（3．69±0．64s；12．85±1.31s）和活化部分凝血活酶时间（34．52±5．41s；35．48±5．32s）的比较差异无统计学意义（P〉0．05）。术后未发现下肢深静脉血栓形成。结论在全髋关节置换术中关节腔内应用氨甲环酸能明显减少患者术后失血量，降低输血率和输血量，并且避免了静脉内应用可能带来的并发症。

Objective To investigate the effect of intra-articular use of Tranexamic acid （TXA） on blood loss after total hip replacement （THR）. Methods Eighty cases scheduled for primary unilateral THR were randomly divided into Groups A and B （n=40 each）. Group A received lg TXA dissolved in 50 ml normal saline by intra-articular injection after suture of joint capsule; and Group B received an equal volume of normal saline alone by intra- articular injection. The postoperative volume of blood loss and blood transfusion, number of blood transfusion cases, postoperative hemoglobin concentration were recorded. The evaluation indexes of fibrinogen, prothrombin time and activated partial thromboplastin time at 3 hours after the operation were recorded. Whether the patients had clinical symptoms of deep venous thrombosis in lower limbs were examined, and all patients were examined by the Doppler uhrasonography on blood vessels in lower limbs at 7 and 14 days after the operation. Results There were statistically significant differences in the volume of blood loss （315±82 ml; 483±105 ml） and blood transfusion （240±35 ml; 482±124 ml）, and the number of transfusion cases （8 cases; 21 cases） between Groups A and Group B （P=0.01, P〈0.05） , respectively. The postoperative hemoglobin concentration in Group A （95±12 g/L） was significantly higher than that in Group B （76±15 g/L） （P=0.01, P〈0.05）. There were no statistically significant differences in fibrinogen （3.72±0.51 g/L; 3.69±0.64 g/L）, prothrombin time （3.69±0.64 s; 12.85±1.31 s） and activated partial thromboplastin time （34.52 ± 5.41 s; 35.48 ± 5.32 s） （P〉0.05）. No postoperative deep venous thrombosis was found in lower limbs. Conclusion Using intra-articular TXA in THA can significantly reduce postoperative blood loss, the rate and volume of blood transfusion, and avoid complications caused by intravenous administration.