静脉应用不同剂量氨甲环酸对全膝关节置换围手术期失血的影响

The Intravenous Application of Different Doses of Tranexamic Acid on Total Knee Replacement Effect of Perioperative Blood Loss

目的:探讨静脉注射不同剂量氨甲环酸对初次单侧人工全膝关节置换围手术期失血量及安全性的影响。方法:选取2012年9月-2014年1月本院骨科行初次单侧人工全膝关节置换患者250例作为研究对象,随机分为空白组、氨甲环酸10 mg/kg组、15 mg/kg组、20 mg/kg组、30 mg/kg,每组50例。应用氨甲环酸的四组分别于松止血带前30 min将氨甲环酸按照10、15、20、30 mg/kg稀释于100 m L生理盐水后静滴。五组患者术后均闭管2 h后开始引流,术后48 h拔管。记录并比较五组患者术后1、3、7 d血红蛋白(Hb)含量和红细胞压积(HCT)、术后最大血红蛋白丢失量、总引流量、总失血量、隐性失血量、输血率、术后下肢静脉血栓发生率及其他并发症等情况。结果:五组术后1、3、7 d Hb含量和HCT比较,除20 mg/kg组与30 mg/kg组比较差异无统计学意义(P>0.05),其余组间比较差异均有统计学意义(P<0.01)。五组术后最大血红蛋白丢失量、总引流量、总失血量及隐性失血量比较,除20 mg/kg组与30 mg/kg组比较无统计学意义(P>0.05),其余组间比较差异均有统计学意义(P<0.01)。应用氨甲环酸的四组输血率与空白组比较差异均有统计学意义(P<0.01),而15 mg/kg组,20 mg/kg组和30 mg/kg组三组间比较差异均无统计学意义(P>0.05)。五组患者术后均未发现静脉血栓栓塞症(VTE)、感染、肾功能衰竭等其他并发症。结论:静脉应用10、15、20、30 mg/kg氨甲环酸均可有效减少膝关节置换围手术期患者的失血量,降低输血率,并不增加围手术期静脉血栓发生率。从降低出血、输血率及可能风险方面分析,20 mg/kg剂量为最佳剂量。

Objective： To evaluate the intravenous injection of different dose of tranexamic acid on primary unilateral total knee arthroplasty peri operative blood loss quantity and safety influence.Method： From September 2012 to January 2014, 250 cases of primary unilateral total knee arthroplasty in our hospital were selected as the research objects, they were randomly divided into the control group, tranexamic acid 10 mg/kg group, 15 mg/kg group, 20 mg/kg group and 30 mg/kg group, each group had 50 eases.Application of tranexamic acid of the four groups respectively at 30 min before tourniquet release the tranexamie acid in accordance with 10, 15, 20, 30 mg/kg diluted in normal saline 100 mL by intravenous drip.Five groups began drainage in postoperative closed tube 2 h and drew tube postoperative 48 h.After 1, 3, 7 days hemoglobin content and hematocrit, most postoperative hemoglobin loss, total drainage volume and total blood loss, hidden blood loss, blood transfusion rate, postoperative venous thrombosis of the lower limbs occurred rate and other complications of five groups were recorded and compared.Result： The hemoglobin content and hematocrit of 1, 3 and 7 d after operation among five groups were compared, there was no significant difference between the 20 mg/kg group and 30 mg/kg group （ P〉0.05 ）, and there were significant differences between the other groups （ P〈0.01 ） . Most postoperative hemoglobin loss, total drainage volume, total blood loss and hidden blood loss in five groups were compared, there was no significant difference between the 20 mg/kg grouo and 30 mg/kg group, and there were significant differences between the other groups （ P〈0.01 ） .The blood transfusion rate between four groups of application tranexamic acid compared with control group had statistically significant （ P〈0.01 ）, among 15, 20 and 30 mg/kg three groups were not statistically significant differences （ P〉0.05 ） .Venous thromboembolism （ VTE ）, infection, renal failure and other complications were not found in the five groups.Conclusion： Intravenous application of 10, 15, 20 and 30 mg/kg dose of tranexamic acid can effectively reduce the blood loss and blood transfusion rates of the patients undergoing total knee arthroplasty, and will not increase the risk of perioperative venous thrombosis.To reduce bleeding, blood transfusion rate and possible risk analysis, 20 mg/kg dose was the best dose.