氨甲环酸与利伐沙班在膝关节置换术中的联合应用效果评价

The effect of tranexamic acid combined with rivaroxaban in knee arthroplasty

目的探讨氨甲环酸与利伐沙班对单侧全膝关节置换后患者减少出血及预防静脉血栓的临床效果。方法入选符合条件的行初次单侧全膝关节置换的120例患者按随机数字表法分为氨甲环酸+利伐沙班组与对照组,分析比较2组患者的失血量和输血量、血红蛋白、红细胞压积、凝血指标、疼痛评分、膝关节活动度、美国膝关节协会评分(KSS)膝关节功能评分、并发症等情况。结果观察组的总失血量、隐形出血量、输血量等水平均明显低于对照组,观察组的输血率远低于对照组,差异均具有统计学意义(P<0.05);2组血红蛋白、红细胞压积水平在围手术期均呈明显的下降趋势,术后1d和3d,观察组的血红蛋白、红细胞压积水平明显高于对照组(P<0.05),术后第5天,2组血红蛋白、红细胞压积水平差异无统计学意义(P>0.05);手术前后,观察组和对照组的纤维蛋白原、凝血酶原时间、活化部分凝血活酶时间差异均无统计学意义(P>0.05);观察组的D-二聚体水平明显低于对照组(P<0.05)。结论氨甲环酸与利伐沙班联合应用于初次单侧全膝关节置换术中,可有效减少出血量,对预防下肢静脉栓塞具有良好效果,值得在临床推广使用。

Objective To investigate the effect of Tranexamic acid combined with rivaroxaban in knee ar- throplasty toon reduce reducing bleeding and to preventing venous thrombosis. Methods One hundred and twenty patients receiving primary unilateral total knee replacement were randomly selected and randomly divided into tranexamic acid＋rivaroxaban group and the control group. Blood loss and blood transfusion, hemoglobin hemato- crit, incidence of coagulation, pain scores, and knee motion degree, KSS knee score, and complications of the two groups of patients were measured, recorded and analyzed. Results The total blood loss, the invisible bleeding, and blood transfusion in the experimental group were significantly lower than that those of the control group, the differences were statistically significant （ P d0.05） ~ Hb, hematocrit （HCT） levels in two groups both showed a clear downward trend; 1 d and 3 d after surgery, Hb and HCT level of the experimental group was were signifi- cantly higher than those of the control group （ P d0.05） ~ before and after surgery, fibrinogen, prothromhin time and activated partial thromboplastin time of the experimental group and the control group were not statistically dif- ferent （ P ~0.05） ; D-dimer levels in the experimental group were significantly lower than that those of the con- trol group （ P d0.05）. Conclusion Using tranexamic acid combined with rivaroxaban using in the primary unilat- eral total knee replacement surgery can effectively reduce the amount of bleeding in patients without affecting the body＇s clotting system and prevent deep vein thrombosis.