氨甲环酸对减少同期双侧全髋关节置换术围术期出血的疗效

Combination of intravenous and local application of tranexamic acid significantly reduce blood loss in simultaneous bilateral total hip arthroplasty

目的探讨静脉结合关节内注射氨甲环酸对于减少同期双侧人工全髋关节置换术后出血的有效性和安全性。方法回顾分析2013-10至2015-08同期行双侧人工全髋关节置换术患者病历资料,实验组在术前静脉给予氨甲环酸1 g,单侧手术结束后分别在关节腔内局部给3 g氨甲环酸,共计24例;选取术中及术后均未使用氨甲环酸的患者病历资料为对照组,共计24例,与实验组对照分析。分析术后引流量、血常规、有无输血、输血量,以及有无症状性静脉栓塞。结果氨甲环酸实验组术后总引流量(355.4 ml)、总失血量(1894.1 ml),隐性失血量(1538.7 ml)、总输血量360 ml、输血率(50%)均显著低于对照组(P<0.05)。实验组在术中失血量(954.2 ml)、出院前血红蛋白水平(95 g/L)、出院前血小板计数(157.8×109/L)与对照组比较差异无统计学意义。两组均未发生症状性静脉血栓和肺栓塞。结论同期双侧人工全髋关节置换术结合静脉及局部使用氨甲环酸可有效减少出血量,且不增加血栓栓塞的风险。

Objective To study the efficacy and safety of tranexamic acid for simultaneous bilateral total hip arthroplasty.Methods From 2013 October to 2015 August,forty-eight simultaneous bilateral total hip arthroplasty（ THA） were retrospectively analyzed. Combination of systemic and local application of tranexamic acid were given in twenty-four cases. No tranexamic acid was used in twenty-four cases as control group. Drain volume,total blood loss,hidden blood loss,transfusion rate and transfusion volume,hemoglobin level,platelet count,and symptomatic venous thromboembolism were recorded and compared. Results Drain volume,total blood loss,hidden blood loss,transfusion rate,transfusion volume in tranexamic acid group and control group were 355. 4 ml and574. 4 ml,1894. 1 ml and 2959. 3 ml,1538. 7 ml and 2384. 9 ml,50. 0% and 100. 0%,360 ml and 1340 ml,respectively,with significant difference（ P 〈0. 05）. There was no difference in intraoperative blood loss. No symptomatic venous thrombombolism was identified in either group. Conclusions Combination of systemic and local application of tranexamic acid significantly reduces blood loss for bilateral simultaneous total hip arthroplasty while does not increase the risk of venous thromboembolism.