氨甲环酸对人工全膝关节置换术后失血量的影响分析

Effects of tranexamic acid on blood loss volume after total knee arthroplasty

目的分析氨甲环酸对人工全膝关节置换术后失血量的影响并观察其安全性。方法选取2012年1月至2015年1月收治的接受人工全膝关节置换术治疗膝骨关节炎(Kellgren-LawrenceⅣ级)患者62例,依据随机平均原则分为研究组和对照组,每组31例。研究组在假体装配完成后,止血带解除前10 min经静脉滴注氨甲环酸(10 mg/kg),3 h后以同样剂量及方式再次给药;对照组患者均给予同等剂量0.9%氯化钠溶液,记录患者术中失血量、术后总失血量、术后显性失血量、术后隐性失血量、术后总引流量、术后前3 d输血量、凝血检测指标(凝血酶原时间、纤维蛋白原、活化部分凝血活酶时间、D-二聚体)、并发症等情况。结果 2组患者术中失血量接近(t=1.238,P>0.05);研究组患者术后总失血量、术后显性失血量、术后隐性失血量、术后总引流量、术后输血量均少于对照组(t=10.237,P<0.05;t=8.446,P<0.05;t=6.014,P<0.05;t=9.667,P<0.05;t=6.159,P<0.05);2组患者术中松止血带时凝血酶原时间、纤维蛋白原、活化部分凝血活酶时间、D-二聚体差异无统计学意义(t=1.205,P>0.05;t=1.557,P>0.05;t=1.662,P>0.05;t=1.147,P>0.05);2组患者术后3 h凝血酶原时间、纤维蛋白原、活化部分凝血活酶时间、D-二聚体差异均无统计学意义(t=1.304,P>0.05;t=2.012,P>0.05;t=1.624,P>0.05;t=1.059,P>0.05);截止术后第15天,研究组患者未发现下肢深静脉栓塞或肺栓塞等临床表现,术后第15天彩色多普勒超声及CT检查未见明显异常。结论在TKA术中及术后短期内运用氨甲环酸能安全减少患者术后的失血量,值得临床借鉴。

Objective To investigate the effects of tranexamic acid on blood loss volume after total knee arthroplasty（ TKA）,and to observe its safety. Methods Sixty-two patients with knee osteoarthritis（ Kellgren-Lawrence grade Ⅳ） who underwent total knee replacement surgery in our hospital from January 2012 to January 2015 were randomly divided into trial group and control group,with 31 patients in each group. The patients in trial group were given tranexamic acid（ 10 mg / kg） by intravenous drip after the prosthesis was assembled and in 10 minutes before tourniquet was removed,ang medication again after 3 hours at the same dose and medication way,however,the patients in control group were given equivalence 0. 9% sodium chloride solution. The intraoperative blood loss volume,postoperative total blood loss volume,postoperative dominance blood loss volume,postoperative recessive blood loss volume,postoperative total draining volume,blood transfusion volume of three days after the operation,blood coagulation indexes including prothrombin time,fibrinogen,activated partial thromboplastin time,D- dimer,and complications were detected and compared between two groups. Results There was no significant difference in the intraoperative blood loss volume between two groups（ P 0. 05）. The postoperative blood loss volume,postoperative dominance blood loss volume,postoperative recessive blood loss volume,postoperative total draining volume,blood transfusion volume after the operation in trial group were significantly less than those in control group（ P 0. 05）.However there were no significant differences in the prothrombin time,fibrinogen,activated partial thromboplastin time,Ddimmer when tourniquet was removed and on 3 hours after operation between two groups（ P 0. 05）. At the end of 15 days after operation,the clinical manifestations including deep venous thrombosis in lower limb and pulmonary embolism in trial group were not observed,moreover,color Doppler ultrasound and CT examination showed no obvious abnormalities on 15 days after operation. Conclusion The application of tranexamic acid during TKA and short- term application after operation can decrease postoperative blood loss volume,with fafety,thus which is worthy of clinical reference.