氨甲环酸不同应用方式对TKA术后失血量及安全性的影响

目的探讨氨甲环酸（TXA）静脉滴注和关节腔局部灌注对老年患者膝关节置换术失血量及其安全性的影响。方法选取2015年3月至2016g-8月行初次行单侧全膝关节置换术的老年患者78例，分为3组，A组术前10min使用TXA15mg／kg静脉滴注；B组在关闭切口后将TXA2g注入关节腔；C组未注射TXA。观察三组患者术后引流量、显性红细胞丢失量、隐性红细胞丢失量、总失血量、输血人数、输血量，是否出现下肢深静脉血栓症状。结果三组患者术后引流量、显性红细胞丢失量、总失血量差异有统计学意义（P〈0．05），A组与B组均低于C组，但A组与B组差异无统计学意义（P〉0．05），在隐性红细胞丢失量上三组比较差异无统计学意义（P〉0．05）。比较输血率和输血量，三组间差异有统计学意义（P〈0．05）。三组均无深静脉血栓发生。结论2种TXA应用方式均可减少术后引流、显性红细胞丢失和总失血量．降低输血率、输血量，且不增加深静脉血栓的发生率。

Objective To investigate the influence and security of tranexamic acid （ TXA ） on blood loss, allogenic blood transfusion during total knee arthroplasty （ TKA ） . Methods Totally 78 elderly patients with total knee arthroplasty treated in the hospital from March 2015 to August 2016 were divided into 3 groups.Patients in group A were given 15mg/kg tranexamic acid with 250ml normal saline intravenously before the surgery, group B intra-articular received 2g tranexamic acid with 20 ml normal saline after surgery, group C was deemed as control group.The postoperative drainage, visible red blood cell （ RBC ） loss, hidden RBC loss, the total blood loss, blood transfusion rate and blood transfusion volume were recorded.Deep-vein thrombosis （ DVT ） were observed. Results The postoperative drainage, visible red blood cell and the total blood loss in three groups had statistically significant （ P〈0.05 ） , hidden RBC loss in three groups had no significant differences （ P〈0.05 ） , date in group A and group B were less than group C, but the differences in group A and B were not significant （ P〉0.05 ） .Blood transfusion rate and blood transfusion volume in three group had significant differences （ P〈0.05） . No DVT was observed in all cases. Conclusion Two different applications of tranexamic acid can significantly reduce the postoperative drainage, visible red blood cell, the total blood loss, blood transfusion rate and blood transfusion volume with no increasing risk of deep venous thrombosis.