氨甲环酸应用于全膝关节置换术围术期的给药方式比较

Topical application of tranexamic acid can not efficiently reduce blood loss during total knee arthroplasty

背景:氨甲环酸(tranexamic acid,TXA)已广泛应用于全膝关节置换术(total knee arthroplasty,TKA)围术期以降低失血量,但其最佳给药方式尚未明确。目的:探讨TKA围术期局部和联合应用TXA降低失血量的有效性与安全性。方法:2014年5月至2015年2月共纳入122例拟行单侧TKA患者,随机分为实验组与对照组,实验组61例,关闭关节囊后给予TXA 2 g关节腔灌注;对照组61例,松止血带前20 min给予TXA 1 g静脉滴注,关闭关节囊后给予TXA1 g关节腔灌注。术后通过血常规及双下肢超声评价两种给药方式的安全性及有效性。结果:实验组总失血量、引流量和术后输血率分别是(1216±327)ml,(307±132)ml,36.07%(22/61),而对照组分别是(779±195)ml,(237±114)ml,11.48%(7/61)。两组总失血量、引流量和术后输血率均有统计学差异(P=0.00、0.002、0.001)。两组的深静脉血栓发生率无统计学差异。结论:TXA联合给药相比单纯局部应用可有效降低引流量及隐性失血量,从而更有效地降低总失血量和输血率,且两种给药方式的安全性相当。

Background： Tranexamic acid（TA） has been widely used to reduce peri-operative blood loss during total knee arthroplasty（TKA）, but optimal dose and regimen has not been confirmed. Objective： To evaluate the efficiency and safety of topical infusion compared with combined systemic and topical application of TA during TKA. Methods： A total of 122 patients undergoing unilateral TKA from May 2014 to February 2015 were randomly divided into two groups（n=61）. In control group, 1.0 g TA was intravenously given 20 min before tourniquet deflation and 1.0 g TA was injected into articular cavity after closing joint capsule. In topical group, 2.0 g TA was injected into articular cavity after closing joint capsule. Hemoglobin, transfusion rate, hemoglobin at discharge and complications were compared between the two groups. Results： The total blood loss, volume of drainage and postoperative hemorrhage rate were（1216±327） ml,（307±132） ml and 36.07% in the topical group, respectively. And they were（779±195） ml,（237±114） ml and 11.48% in the control group. There were significant differences in the total blood loss, volume of drainage and postoperative hemorrhage rate between groups（P=0.00,0.002, 0.001）. Conclusions： Topical application of TA can not efficiently reduce blood loss during unilateral TKA.