氨甲环酸在全膝关节置换中的应用及安全性

Application and safety of tranexamic acid in total knee arthroplasty

背景:研究表明全膝关节置换出血量往往较大,甚至需要输血。而止血带的应用会破坏纤溶/凝血系统,不利于置换后伤口止血。近几年来,氨甲环酸由于低廉的使用价格、简单的给药途径、超高的止血效价被广泛应用于减少全膝关节置换失血。目的:综述近年国内外氨甲环酸在全膝关节置换中的应用效果及安全性。方法:第一作者应用计算机检索至2015年10月PubM ed数据库、中国期刊全文数据库的相关文章,英文检索词"tranexamic acid,total knee arthroplasty,hemorrhage",中文检索词"氨甲环酸,全膝关节置换,出血"为中文检索词。共检索到200余篇相关文献,50篇文献符合纳入标准。结果与结论:氨甲环酸是一种纤溶抑制剂,能可逆的阻断纤溶酶原与纤维蛋白之间的结合,有效抑制纤维蛋白溶解,减少全膝关节置换后出血。但氨甲环酸的用法、用量及在止血中的效果在众多文献中存在很大差异。氨甲环酸作为全膝关节置换的有效止血药物,其在全膝关节置换中的临床作用包括减少置换后显性失血和隐形失血,且不会增加下肢静脉血栓形成的风险。目前氨甲环酸的应用时机、使用剂量、给药途径及可能发生的并发症仍存在着争议,尚无统一标准。

BACKGROUND： Studies suggested that blood loss was great during total knee arthroplasty, even blood transfusion was needed. Application of the tourniquet will destroy the coagulation system, and is not conducive to hemostasis after replacement. Recently, tranexamic acid has been extensively used to reduce blood loss during total knee arthroplasty, because of low price, simple administration pathway, and effective effects on hemostasis. OBJECTIVE： To summarize the application and safety of tranexamic acid in total knee arthroplasty. METHODS： The first author retrieved Pub Med and Chinese Journal Full Text Database for articles from inception to October 2015. The key words were tranexamic acid, total knee arthroplasty, hemorrhage. More than 200 articles were retrieved, and finally 50 articles met the inclusion criteria. RESULTS AND CONCLUSION： Tranexamic acid is a fibrinolytic inhibitor, can reversibly block the binding of plasminogen to fibrin, effectively inhibit fibrinolysis, and reduce hemorrhage after total knee arthroplasty. Nevertheless, there were significant differences in the use, dose and effect of tranexamic acid on hemostasis among different studies. Tranexamic acid was an effective drug for hemostasis during total knee arthroplasty. During total knee arthroplasty, tranexamic acid had been used to reduce dominant blood loss and hidden blood loss after arthroplasty, and could not increase the risk for venous thrombosis of lower limb. Currently, the timing of use, dosage, route of administration, and possible complications of tranexamic acid remain controversial.