关节腔内灌注氨甲环酸对高龄人工股骨头置换术失血量的影响及安全性探讨

Influence and safety of intra-articular injection of tranexamic acid on blood loss in elderly patients with bipolar artificial femoral head arthroplasty

目的探讨关节腔内使用氨甲环酸(tranexamic acid,TXA)对高龄双极人工股骨头置换术后失血量的影响及安全性。方法将60例拟行人工股骨头置换术的高龄股骨颈骨折患者按随机数字表法分为实验组与对照组,每组30例。实验组在关闭切口后关节腔内注入3 g TXA,加生理盐水稀释至50 ml;对照组给予关节腔内注入50 ml生理盐水,术后闭合引流2 h。比较两组患者总失血量及输血率、术后下肢深静脉血栓形成(deep vein thrombosis,DVT)和肺栓塞(pulmonary embolism,PE)发生率,以及比较两组术中显性失血量、术后引流量、隐性失血量及切口并发症。结果实验组术中出血量与对照组比较差异无统计学意义(P>0.05)。实验组患者术后引流、隐形失血量、输血率及总失血量均低于对照组,差异有统计学意义(P<0.05)。两组均无PE及DVT,对照组有3例、实验组有4例术后发生肌间静脉血栓,两组比较差异无统计学意义。结论高龄股骨头置换术中关节腔内使用TXA能显著减少患者术后失血量及输血率,且不会增加术后DVT及PE的发生率,是高龄人工股骨头置换围手术期控制失血量的安全、有效的方法。

Objective To investigate the effectiveness and safety of tranexamic acid（ TXA） on reducing blood loss during the intraoperative period in elderly patients who underwent primary unilateral bipolar artificial femoral head replacement. Methods Sixty patients who were scheduled to receive primary unilateral bipolar artificial femoral head replacement were randomly divided into the TXA group（ n = 30） and the control group（ n = 30）. The TXA group received intra-anicular injection of 3 g tranexamic acid with 50 ml physiological saline,the control group received the same volume of physiological saline injection after the incision was closed. Drainagetube was clamped for 2hours. The total blood loss,transfusion rate,the incidence of deep vein thrombosis（ DVT）,pulmonary embolism（ PE）,the postoperative drainage,intraoperative blood loss,hidden blood loss and complications were compared between the two groups. Results The total blood loss,postoperative drainage,hidden blood loss and blood transfusion rate in the TXA group were significantly less than those in the control group（ P〈0. 05）. No PE and DVT occurred in the two group. Calfmuscular venous thrombosis was found in 3 cases in the TXA group and 4 pations in the control group,without a significant difference between the two groups（ P〉0. 05）. Conclusion Intra-articular injection of tranexamic acid is safe and effective in the treatment of blood loss in elderly patients with bipolar artificial femoral head replacement.