氨甲环酸在首次人工全膝关节置换术围手术期减少出血的研究

Effects of tranexamic acid on blood loss in perioperative period of primary total knee arthroplasty

目的探讨氨甲环酸在首次人工表面全膝关节置换术(TKA)围手术期减少出血的作用。方法 2011年3月至2014年1月,选取62例在中山大学附属第一医院东院关节外科行人工表面TKA患者作为研究对象,所有患者均无凝血功能障碍,术前已停用抗血小板药物至少1周,排除对氨甲环酸禁忌及严重内科疾病未控制等患者。按随机数表分配患者为氨甲环酸注射组和0.9%氯化钠注射组。氨甲环酸注射组在缝合关节囊时将1 g氨甲环酸稀释于100 ml 0.9%氯化钠注射液静脉滴注;0.9%氯化钠注射组静脉输注等量0.9%氯化钠注射液。术后计算两组显性红细胞丢失量、隐性红细胞丢失量、总红细胞丢失量,记录输血量及输血例数、下肢瘀斑面积及静脉血栓发生的例数;术后采用美国特种外科医院(HSS)膝关节评分评估关节情况。应用SPSS 17.0统计学软件对相关数据进行分析,其中计数资料使用x2检验,组间相关测量指标比较使用独立样本t检验,使用重复测量资料方差分析术前与术后重复测量的相关指标。结果氨甲环酸注射组、0.9%氯化钠注射组两组总红细胞丢失量分别为(384±61)ml和(492±79)ml,两组差异有统计学意义(t=4.114,P<0.05),显性红细胞丢失量分别为(226±24)ml和(268±28)ml,两组差异有统计学意义(t=2.778,P<0.05),隐性红细胞丢失量分别为(168±48)ml和(223±63)ml,两组差异有统计学意义(t=3.042,P<0.05);输血量分别为(175±20)ml和(306±20)ml,两组差异有统计学意义(t=4.633,P<0.05);两组输血例数分别为14和26,两组差异有统计学意义(x2=16.442,P<0.05);两组术后下肢瘀斑面积分别为(4.9±1.1)%和(10.1±1.5)%,两组差异有统计学意义(t=3.239,P<0.05);两组术后均未发现肺栓塞或下肢血栓。结论使用氨甲环酸可降低输血量、减小术后下肢瘀斑的面积,并且没有增加TKA术后血栓或栓塞的发生率。

Objective To investigate the effects of tranexamic acid on the hidden blood （loss lower extremity ecchymosis ） following total knee arthroplasty （TKA）. Methods From March 2011 to January 2014, 62 patients underwent TKA in department of joint surgery, the Eastern Hospital of the First Affiliated Hospital, Sun Yat-sen University. A random number table was used to assign the patients into the tranexamie acid group and the normal saline group, 31 cases each group. In the tranexamic acid group, 1 g tranexamic acid dissolved in 100 ml of normal saline was intravenously infused when suturing the joint capsule. The total red blood cell loss of the two groups was measured. The ecchymosis area was measured with palm method. The amount of blood transfusion, case number of blood transfusion, the the case of venous thrombosis and embolism were recorded; the knee joints were evaluated by score of hospital for special surgery （HSS）. The statistical analyses were performed using SPSS 17. 0 software. Chi-square test was used to analyze the equal sun-class number; comparison of correlation measurements between two groups was performed by independent t-test; repeated ANOVA was used to analyze preoperative and postoperative repeated measures. Results In the tranexamic acid group and the normal saline group, the visible red blood cell loss were （226 ± 24） ml and （268± 28 ） ml respectively with significant difference （ t = 2. 778, P 〈 0. 05） ; the hidden red blood cell loss in the tranexamic acid group and the normal saline group were （ 168 ± 48） ml and （223 ± 63 ） ml with significant difference （ t = 3. 042, P 〈 0.05 ） ; the total red blood cell loss were （384 ±61 ） ml in the tranexamic acid group and （492 ± 79） ml in the normal saline group with significant difference （t =4. 114, P 〈0. 05） ; the blood transfusion volume were （ 175 ± 20） ml in the tranexamic acid group and （306 ± 20） ml in the normal saline group with significant difference （t =4. 633, P 〈0. 05） ; the blood transfusion cases were 14 cases in the tranexamic acid group and 26 cases in the normal saline group with significant difference （ %2 = 16. 442, P 〈 0.05 ）. The ecchymosis area was （4. 9 ± 1.1 ） % in the tranexamic acid group and （ 10. 1 ±1.5 ） % in the normal saline group. Eechymosis area was significantly less the tranexamic acid group than that in the normal saline group, and the difference was significant （t = 3. 239, P 〈 0. 05）. No pulmonary embolism or lower extremity thrombosis was found after the operation in the two groups. Conclusion During TKA operation, use of tranexamic acid can significantly decrease the visible red blood cell loss, the hidden red blood cell loss and blood transfusion without increasing the risk of thrombosis or embolism.