氨甲环酸对全髋关节置换术的影响

Effects of tranexamic acid on total hip arthroplasty

目的探讨非骨水泥型全髋关节置换术术前静脉使用单剂量氨甲环酸对失血量、输血率及术后恢复的影响。方法回顾性对比分析了2014年6月至2015年6月行初次全髋关节置换术的患者96例,其中氨甲环酸组61例,于术前单剂量使用15 mg/kg氨甲环酸,健康对照组35例,未使用氨甲环酸。采用成组设计资料t检验比较两组术中出血量、术后引流量、术后血红蛋白、术后10 d及术后3个月髋关节Harris功能评分等;性别、输血比例、手术时间、住院日则采用卡方检验。结果氨甲环酸组术中出血量(327±187)ml低于健康对照组(514±342)ml,组间差异有统计学意义(t=-3.472,P<0.01);氨甲环酸组术后引流量(449±186)ml低于健康对照组(552±233)ml,组间差异有统计学意义(t=-2.25,P<0.01);氨甲环酸组输血率6.5%(4/61)低于健康对照组22.8%(8/35),组间差异有统计学意义(2=4.015,P<0.05);氨甲环酸组术后10 d髋关节Harris评分(51±7)分高于健康对照组(47±8)分,组间差异有统计学意义(t=2.804,P<0.01);氨甲环酸组术后3个月髋关节Harris评分为(71±9)分,与健康对照组(70±8)分比较差异无统计学意义(t=0.333,P>0.05)。结论对于初次单侧THA术前单剂量使用氨甲环酸能减少术中出血量及术后引流量,并降低输血率,并促进患者早期恢复,但对后期恢复无明显影响。

Objective To explore the effects of preoperative administration of intravenous single bolus of 15 mg tranexamic acid （TXA） in blood loss, transfusion rates and postoperative recovery in primary unilateral cementless total hip arthroplasty （THA）. Methods A retrospective study was carried out in 96 patients who underwent primary unilateral cementless THA from June 2014 to June 2015 ; 61 of them received TXA preoperatively （ the TXA group） while 35 patients （ the control group） did not. The intra- operative blood loss, postoperative drainage, postoperative Harris hip score （10 d and three months） of the two groups were compared by t test; the sexual proportion, transfusion rate, operation time, and length of stay were analyzed by chi-square. Results The intra - operative blood loss in TXA group [（327 ±187） ml] was lower than the control group [ （514 ±342） ml]; the difference was significant （t = -3.472, P 〈 0. 01 ）. The volume of drainage in the TXA group [ （449 ± 186） ml] was lower than the control group [ （552 ± 233） ml ], the difference between the two groups was significant （ t = - 2. 25, P〈0. 01）. The transfusion rate was lower in the patients receiving TXA （6. 5% ） compared with the control group （22. 8% ） ; the difference was significant （2 = 4. 015, P 〈 0. 05 ）. The Harris hip score on the 10th day postoperatively in the TXA group （51 ± 7 ） was higher than the control group （47 ± 8 ） ; the difference was significant （ t = 2. 804, P 〈 0. 01 ）. The Harris hip score in three months after the operation between the two groups were similar （71 ± 9 vs 70 ± 8 ; t = 0. 333, P 〉 0. 05 ）. Conclusion For primary unilateral cementless THA, pre- operative intravenous single dose of 15rag TXA can reduces the intra - operative blood loss and the postoperative drainage volume; it also can decrease the rates of blood transfusion, promote the early rehabilitation, but has no effects on recovery.