全髋关节置换术围手术期氨甲环酸不同联合用法的止血效果分析

Analysis of hemostatic effect of tranexamic acid with different combined usage during perioperative period of total hip replacement

目的比较初次单侧全髋关节置换术(THA)围手术期氨甲环酸(TXA)不同联合用法的止血效果。方法回顾性分析自2014-02—2016-02完成的88例初次单侧THA,47例采用术前静脉滴注联合术后经引流管逆行灌注TXA(A组),41例采用术中局部浸润联合术后经引流管逆行灌注TXA(B组)。比较2组手术时间、术中失血量、术后引流量,术后第1天及第3天血红蛋白(Hb),以及术后第3天凝血酶原时间(PT)、活化部分凝血酶时间(APTT)。结果 2组手术时间、术中失血量、术后引流量、术后第1天Hb、术后第3天Hb、术后第3天PT、术后第3天APTT、输血例数、术后DVT发生例数比较差异均无统计学意义(P>0.05)。结论 THA术前静脉滴注及术中局部浸润TXA起到一定程度的止血作用,术后经引流管逆行灌注TXA起到进一步止血作用。术中局部浸润在不延长手术时间的情况下与术前静脉滴注达到相似的止血效果,同时术中局部浸润操作简单。

Objective To compare the hemostatic effect of two combined kinds of usage of tranexamic acid （TXA） during the perioperative period of the primary unilateral total hip arthroplasty （THA）. Methods Eighty eight cases of primary unilateral THA from February 2014 to February 2016 were retrospectively analyzed. Forty-seven cases were treated w^th preoperative intravenous infusion combined with postoperative drainage tube retrograde perfusion with TXA （group At~＇ while 41 eases＇ were treated with intraoperative local infiltration and postoperative drainage tube retrograde perfusion TXA （groupB）. The operative time, intraoperative blood loss, postoperative drainage volume, hemoglobin （Hb） on the 1st day and the 3rd day after operation, and prothrombin time （PT） and activated partial thromboplastin time （APTr） on the 3rd day after operation were compared between the two groups. Results There were no significant differences in operative time, intraoperative blood loss, postoperative drainage volume, Hb 0n the 1st day and the 3rd day after operation, PT on the 3rd day after operation, APTT on the 3rd day after operation, blood transfusion and postoperative DVT number between two groups （P 〉0.05）. Conclusion THA preoperative intravenous infusion and intraoperative local infiltration TXA could play a role in hemostasis to a certain extent, and postoperative drainage tube retrograde perfusion TXA could have further hemostatic effect. Under the condition of no prolonged operative time, the intraoperative local infiltration TXA has the same hemostatie effect with preoperative intravenous infusion TXA, with easier operation.