氨甲环酸不同途径用药对全膝关节置换术失血量的影响

Comparison of Effects on Intravenous and Intra-Articular Cavity Injection of Tranexamic Acid on Blood Loss Volume in Total Knee Arthroplasty

目的:分析氨甲环酸静脉滴注与关节腔内局部注射对控制全膝关节置换手术失血量的有效性及安全性。方法:选取2012年1月—2014年10月收治的行全膝关节置换术患者73例随机分为静脉滴注组40例和腔内注射组33例,静脉组在麻醉诱导期使用氨甲环酸10 mg/kg体重,最大剂量1 g;腔内组关节囊缝合完成且止血带未放松前,将氨甲环酸1 g注入关节腔。记录两组患者术后引流量、隐性失血量、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT),观察患者是否出现下肢深静脉栓塞症状。结果:腔内组患者术后引流量(252±63)m L低于静脉组(545±61)m L,隐性失血量(603±59)m L低于静脉组(882±114)m L,差异具有统计学意义。腔内组患者PT、APTT、INR与静脉组比较差异无统计学意义(P>0.05)。每组1例发生深静脉血栓。结论:关节腔内注射氨甲环酸,能有效控制全膝关节置换术后失血量,且相对安全,并不增加术后深静脉血栓发生机率。

ObjectiveTo compare the effects and operative safety of intravenous drip and intra-articularcavity local injection of tranexamic acid on controlling blood loss volume in total knee arthroplasty.Methods Totally 73 patients with total knee arthroplasty treated in the hospital from January 2012 to October 2014 were randomly divided into the intravenous drip group（IVTA）（40 cases）and the intra-articular use group（IATA）（33 cases）.The patients in the control group used intravenous tranexamic acid 10 mg/kg,with the maximumdose 1.0g during the anesthetic induction period,while the patients in the treatment group were intra-articularllyinjected by tranexamic acid 1g at the finishing of articular capsule suture and before relaxing the tourniquet.Thepostoperative blood loss,the hidden blood loss,prothrombin time（PT）,activated partial thromboplastin time（APTT）were recorded for both groups.Deep-vein thrombosis（DVT）were observed.ResultsThe postopera-tive blood loss and the hidden blood loss of IATA group [（252±63）m L,（603±59）m L]was lower than that of IV-TA group [（545±61.87）m L,（882±114）m L]（P〈0.05）.There were no significant differences in the two groupsin PT、APTT、INR[（13±1.1）vs（12±0.8）,（32±2.1）vs（33±1.8）,（1±0.1）vs（1±0.1）]（P〈0.05）.ConclusionTranexam-ic acid injected intra-articular can significantly and safely reduce blood loss with no increasing risk of deep ve-nous thrombosis.