氨甲环酸不同使用方法对全膝关节置换围术期失血量的影响和安全性评价

Effectiveness and safety of different regimens of tranexamic acid on perioperative blood loss in patients with total knee arthroplasty

目的 探讨氨甲环酸不同使用方法对全膝关节置换围术期失血量的影响与安全性。方法 选取2016年3月至2017年2月于首都医科大学附属北京世纪坛医院因终末期膝关节病行初次单侧全膝关节置换术的患者90例，完全随机分为3组：分别于手术结束前10 min静脉滴注氨甲环酸15 mg/kg（单次组）；于手术开始前1 h及手术结束前10 min各静脉滴注氨甲环酸15 mg/kg（重复组）；不使用氨甲环酸（对照组）。记录术前、术后第3天患者的血红蛋白、红细胞比容，以及术后引流量、输血量等指标，观察患者是否出现下肢深静脉血栓的临床症状，并于术前、术后14 d进行下肢血管多普勒检查。结果 单次组和重复组术后引流量、总失血量均明显少于对照组［（253±79）、（165±83）ml比（463±174）ml，（865±241）、（742±213）ml比（1 132±319）ml］，且重复组少于单次组，差异有统计学意义（P＜0.01或P＜0.05），隐性失血量3组差异无统计学意义（P〉0.05）。3组患者异体输血率为单次组23.3%（7/30）、重复组13.3%（4/30）、对照组43.3%（13/30），两两比较差异均有统计学意义（均P＜0.05）。所有患者术后14 d内均无下肢深静脉血栓形成。结论 静脉滴注氨甲环酸可减少全膝关节置换术后引流量及围术期总失血量，降低输血率，术前1 h及手术结束前10 min重复使用效果更好，且不增加深静脉血栓的发生率。

Objective To investigate the effect and safety of different regimens of tranexamic acid on perioperative blood loss in patients with total knee arthroplasty（TKA）. Methods A prospective study was carried out in 90 patients who had unilateral TKA for end-stage knee osteoarthritis from March 2016 to February 2017 in Beijing Shijitan Hospital, Capital Medical University. The patients were randomly divided into 3 groups; the single-use group had 15 mg/kg tranexamic acid by intravenous infusion 10 min before the end of operation; the repeated-use group had 15 mg/kg tranexamic acid by intravenous infusion 1 h before operation and 10 min before the end of operation; the control group had no special drug administration. Hemoglobin concentration and hematocrit before and on the 3rd day after operation, postoperative drainage, blood transfusion volume and adverse manifestations of deep venous thrombosis（DVT） were observed. Doppler ultrasonography on lower limb vessels was performed before and 14 d after operation. Results Postoperative drainage volume and total blood loss in single-use group and repeated-use group were significantly less than those in control group[（253±79）, （165±83）ml vs （463±174）ml; （865±241）, （742±213）ml vs （1 132±319）ml]; there were differences between single-use group and repeated-use group（P〈0.01 or P〈0.05）. There was no significant difference of hidden blood loss among groups（P〉0.05）. The blood transfusion rate was 23.3%（7/30） in single-use group, 13.3%（4/30） in repeated-use group and 43.3%（13/30） in control group; there were differences among 3 group（P〈0.05）. No symptomatic DVT was observed within 14 d after operation. Conclusion Intravenous infusion of tranexamic acid can decrease postoperative drainage, blood loss and blood transfusion without increasing risk of DVT in patients with TKA.