全髋关节置换术中氨甲环酸联合给药与静脉给药的对照研究

The comparision study of combined administration of tranexamic acid and intravenous injection on total hip arthroplasty

目的比较全髋关节置换术中单次氨甲环酸(TA)静脉注射结合局部关节腔灌注与两次静脉给药法的有效性及安全性。方法将我院收治的117例拟行单侧THA患者随机分为观察组(61例)与对照组(56例)。观察组切皮前20 min给予1.0 g TA静脉滴注,缝合后给予1.0 g TA灌注,对照组分别于切皮前20 min和术后3 h给予1.0 g TA静脉滴注。比较两组患者血红蛋白降幅、总失血量、输血情况、术后引流量及深静脉血栓(DVT)发生率。结果两组患者血红蛋白降幅、总失血量、术后输血情况比较(P>0.05),观察组术后引流量为(171±152)m L,低于对照组的(241±174)m L(P=0.023)。术后7 d,两组各有6例DVT发生(P>0.05)。结论联合给药法具有与传统的两次静脉给药法有相当的疗效与安全性,且引流量更少,值得进一步研究。

Objective To compare the efficiency and safety of single tranexamic acid （TA） intravenous injection combined intra-articular perfusion and twice tranexamic acid intravenous injection on total hip arthroplasty （THA）. Methods One hundred and seventeen cases of patients with unilateral THA admitted in our hospital were selected and randomly divided into observation group （61 cases） and control group （56 cases）. The observation group received one dose of 1.0 g TA intravenous injection 20 minites before incision and one dose of 1.0 g TA perfusion into articular cavity after the suture, while the control group received one dose of 1.0 g TA intravenous injection 20 minites before incision and same dose 3 hours later. The hemoglobin reduction, total blood loss, blood transfusion, postoperation suction drainage, and the incidence rate of deep vein thrombosis between the two groups were compared. Results The hemoglobin reduction, total blood loss, blood transfusion had no significant difference between the two groups （P〉0.05）; the postoperation suction drainage was （171±152） mL of the observation group, which were significantly lower than （241±174） mL of the control group （P=0.023）, there were 6 cases of DVT in each group 7 days after the operation （P〉0.05）. Conclusion Combined administration of tranexamie acid on total hip arthroplasty has similar safety and effect as the traditional twice intravenous injection, with a lower postoperative suction drainage, which is worthy of further study.