氨甲环酸减少单侧初次全膝关节置换术后失血的疗效分析

Clinical effect of tranexamic acid on postoperative blood loss in patients with unilateral primary total knee arthroplasty

目的探讨在初次接受单侧全膝关节置换患者围手术期采用氨甲环酸减少出血的有效性和安全性。方法将100例接受单侧初次膝关节置换的患者随机分为观察组(n=50)和对照组(n=50)。观察组患者在松止血带时使用1 g氨甲环酸加至250 ml生理盐水中静点,缝合关节囊时局部注射1 g氨甲环酸;对照组同样时间给予等量生理盐水静点和局部注射。记录所有患者术后引流血量、隐性失血量、术后输血量、凝血酶原时间和活化部分凝血酶时间,术后第1天、第3天的血红蛋白量和血细胞比容,术后第7天进行下肢深静脉超声检查。比较两组患者术后显性失血量,隐形失血量,血红蛋白值,血细胞比容以及输血量及输血人数,是否出现肺栓塞及下肢深静脉血栓的情况。结果观察组患者术后隐性失血量及各项检验指标均较对照组明显减少,差异有统计学意义(P<0.05);在对照组中出现1例腘静脉血栓,观察组中出现1例肌间静脉血栓,两组患者均无肺栓塞发生。结论围手术期采用氨甲环酸能明显减少单侧初次全膝关节置换术后患者的失血量及输血量,同时并不增加血栓形成风险。

Objective To explore the effect and safety of application of tranexamic acid （TXA） on amount of blood loss during operative period in patients with primary unilateral total knee replacement.Methods A total of 100 patients received primary unilateral total knee replacement were enrolled and randomized into study group （n=50） and control group （n=50）.Patients in study group were given with 1 g TXA by intravenous administration before release of tourniquet and intra-articular injection and close of the joint capsule, and patients in control group were given with normal saline at the same dosage.The amount of intraoperative blood loss, volume of postoperative drainage, hidden blood loss, the volume of blood transfusion, prothrombin time （PT） and activated partial thromboplastin time （APTT） were recorded.The re-examination of blood routine was conducted at 1 and 3 days after the operation, and the hemoglobin level and hematocrit were recorded.The color Doppler flow imaging of lower limbs was performed again at 7 days after the operation.Results In patients of study group, the amount of intraoperative blood loss, volume of postoperative drainage, amount of visible blood loss, hidden blood loss and the volume of blood transfusion were less than those of patients in control group, and the difference was statistically significant （P〈0.05）.Popliteal vein thrombosis was detected in one case of control group, and calf muscular venous thrombosis was found in one case of observation group.There was no significant difference between these two groups about PT and APTT.Conclusion The application of TXA can significantly decrease the amount of blood loss during operative period in patients underwent primary unilateral total knee replacement without increasing the risk of deep venous thrombosis.