氨甲环酸在全髋关节置换术中的效果观察

Effect of tranexamic acid on total hip arthroplasty

目的探讨氨甲环酸减少全髋关节置换术中出血情况和输血效果及术后关节功能恢复的影响。方法选取2013年2月至2015年2月我院收治的62例需行全髋关节置换手术的患者临床资料。采用系统随机化法分为对照组31例和观察组31例。采用氨甲环酸进行止血的患者为观察组，未采用氨甲环酸止血的患者为对照组。对比两组患者手术前后的Hct、Hb及Harris评分，同时比较两组患者总失血量、术中出血量、术后引流量、隐性失血量及输血量。结果术前Hct观察组0.43±0.06，对照组0.42±0.05；Hb观察组（131.13±18.52） g/L，对照组（130.42±14.36） g/L；Harris评分观察组（23.45±10.24）分，对照组（24.36±9.34）分；术后第1、3天Hct观察组0.35±0.05、0.28±0.05，对照组0.30±0.06、0.25±0.03；Hb观察组（111.58±20.32） g/L，对照组（121.26±18.28） g/L；Harris评分术后2、6、12周观察组（54.88±6.14）、（67.79±12.05）、（83.55±12.12）分，对照组（50.21±5.01）、（58.17±13.24）、（74.38±12.67）分，与治疗前相比均有显著改善，且3项观察组患者的改善情况明显优于对照组（F组间＝3.213、P＝0.023，F交互＝3.213、P＝0.036，F组内＝3.327，P＝0.032；F组间＝3.277、P＝0.002，F交互＝2.865、P＝0.006，F组内＝3.564，P＝0.001；F组间＝3.327、P＝0.016，F交互＝32.912、P＝0.005，F组内＝3.614，P＝0.001）。观察组的患者总失血量为（1 820.9±367.6） ml、术中出血量为（685.5±363.62） ml、术后引流量为（561.3±366.1） ml、隐性失血量为（530.8±410.7） ml及输血量为（210.1±25.9） ml，均少于对照组的（2 229.0±564.6） ml、（1 010.3±415.11） ml、（725.9±257.8） ml、（798.4±279.5） ml、（701.2±51.2） ml，两组比较差异均有统计学意义（t＝3.373、3.281、2.047、2.999、47.655，P均〈0.05）。结论氨甲环酸对全髋关节置换术进行术中止血，可以有效的降低出血量和输血量，且对患者术后关节功能恢复起到促进作用，临床推广和使用价值大。

ObjectiveTo study the effect of tranexamic acid of reducing the bleeding and transfusion on total hip arthroplasty and the recovery of joint function. MethodsThe clinical data of 62 patients who underwent total hip arthroplasty from February 2013 to February 2015 were randomly divided into the control group（31 cases） and the observation group（31 cases）. Patients treated with tranexamic acid for hemostasis were the observation group and patients without tranexamic acid for the control group.The Hct, Hb and Harris scores were compared before and after operation.The total blood loss, intraoperative blood loss, postoperative drainage, occult blood loss and blood transfusion were compared between the two groups.ResultsThe preoperative Hct, Hb and Harris scores in observation group were 0.43±0.06, （131.13±18.52） g/L and （23.45±10.24） points, respectively, 0.42±0.05, （130.42±14.36） g/L and （24.36±9.34） points, respectively in control group.Postoperative 1st, 3th d Hct in observation group were 0.35±0.05, 0.28±0.05, in control group were 0.30±0.06, 0.25±0.03, postoperative Hb in observation group were （111.58±20.32） g/L, （121.26±18.28） g/L in control group.Postoperative 2nd, 6th, 12th weeks Harris scores in observation group were （54.88±6.14） points, （67.79±12.05） points, （83.55±12.12） points, in control group were （50.21±5.01） points, （58.17±13.24） points, （74.38±12.67） points, compared with before treatment were improved, and three indexes in the observation group were significantly higher than those in control group（F between grouP=3.213, P=0.023, F across grouP=3.213, P=0.036, F inner grouP=3.327, P=0.032; F between grouP=3.277, P=0.002, F across grouP=2.865, P=0.006, F inner grouP=3.564, P=0.001; F between grouP=3.327, P=0.016, F across grouP=32.912, P=0.005, F inner grouP=3.614, P=0.001）. The patients total blood loss, the amount of hemorrhage, postoperative drainage volume, the hidden blood loss and blood transfusion in the observation group were （1 820.9±367.6） ml, （685.5±363.62） ml, （561.3±366.1） ml, （530.8±410.7） ml and （210.1±25.9） ml, respectively, less than the control group（（2 229±564.6） ml, （1 010.3±415.11） ml, （725.9±257.8） ml, （798.4±279.5） ml, （701.2±51.2） ml, with significant differences between the two groups（t=3.373, 3.281, 2.047, 2.999, 47.655, P〈0.05）.ConclusionIntraoperative hemostasis of tranexamic acid in total hip arthroplasty can effectively reduce the amount of blood loss and blood transfusion, and to promote patients recovery of joint function, clinical promotion, with great value of clinical promotion.