局部使用氨甲环酸联合肾上腺素对全髋关节置换术后失血量的影响

Effects of topical application of tranexamic acid plus adrenaline in total hip arthroplasty

目的评估氨甲环酸联合肾上腺素关节腔内局部使用对全髋关节置换(THA)术后失血量影响。方法将55例单侧股骨头坏死行THA患者根据局部使用药物不同分为试验组(术中关节腔内注射氨甲环酸联合肾上腺素混合液,21例)和对照组(术中关节腔内注射氨甲环酸,34例)。比较两组以下指标:隐性失血量,总失血量,输血量,输血率,术后第1、3、5天血红蛋白,D-二聚体,术后深静脉血栓(DVT)发生率。结果试验组的隐性失血量及总失血量均低于对照组(P<0.05)。两组术后24 h D-二聚体值差异无统计学意义(P>0.05)。两组血红蛋白值在术后第3天达最低,而试验组高于对照组(P<0.05),术后第1、5天两组差异无统计学意义(P>0.05)。试验组有2例、对照组有4例接受异体输血,差异无统计学意义(P>0.05)。术后试验组有2例、对照组有3例发生下肢远端DVT,差异无统计学意义(P>0.05)。结论 THA术中使用氨甲环酸联合肾上腺素关节腔内局部注射,可有效降低隐性失血量及总失血量,而不增加DVT的风险。

Objective To evaluate the intra-articular topical tranexamic acid plus epinephrine effect of perioperative blood loss on total hip arthroplasty（ THA）. Methods There were 55 patients with unilateral femoral head necrosis who were treated by THA. These patients were divided into experimental group（ the intra-articular topical tranexamic acid plus epinephrine,21 patients） and control group（ the intra-articular topical tranexamic acid,34 patients）. The data were compared including hidden blood loss,total blood loss,transfusion volume,rate of blood transfusion,postoperative 1,3,5 d hemoglobin（ Hgb）,postoperative 24 h D-dimer values,and incidence rate of deep vein thrombosis（ DVT） in the two groups. Results The hidden blood loss and total blood loss was lower in the experimental group than in the control group（ P〈0.05）; the level of Hgb of two groups reached the lowest value on the third day after surgery,and the level of Hgb was higher in the experimental group than in the control group（ P〉0.05）; there were not statistically significant differences in postoperative 24 h D-dimer values,the level of Hgb at postoperative 1,5 d（ P〉0.05）. There were 2 cases of experimental group and 4 cases of control group needed transfusion,the rate of transfusion was similar in both groups（ P〉0.05）. DVT was 2 cases in the experimental group and 3 cases in the control group（ P〈0.05）. Conclusions The topical application of tranexamic acid plus adrenaline in total hip arthroplasty,which can reduce blood loss significantly without increasing the DVT.