全髋关节置换术中局部应用氨甲环酸的止血效果及对下肢静脉血栓等并发症的影响

Study on the Hemostatic Effect of Total Hip Arthroplasty in the Local Application of Tranexamic Acid and its Effect on Lower Extremity Venous Thrombosis and other Complications

目的探讨单侧非骨水泥全髋关节置换术中局部应用氨甲环酸的止血效果及对下肢静脉血栓等并发症的影响。方法研究组手术缝皮后关节腔内注射氨甲环酸,对照组则注射生理盐水。记录两组患者失血量,并且统计输血量与输血率;查术前、术后24 h血红蛋白(HGB)、红细胞比积(PCV)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、血浆纤维蛋白原(FIB)、血小板(PLT),术后48 h再次复查HGB、PCV,观察指标变化;查下肢深静脉血栓(DVT)发生情况,并统计肺栓塞的发生率。结果研究组围手术期失血量、输血量与输血率均明显少于对照组(P<0.05);研究组术后24 h、48 h,Hb水平、PCV均高于对照组(P<0.05);研究组术后PT、aPTT、TT、PLT均高于对照组;研究组术后Fbg低于对照组,但均属正常范围波动;两组发生DVT、肺栓塞并发症无统计学差异(P>0.05)。结论全髋关节置换术中局部应用氨甲环酸能够减少术后的出血,同时可预防下肢静脉血栓的发生。

Objective To investigate the arthroplasty in the local application of tranexamic acid hemostatie effect of unilateral eement]ess total hip and its effect on lower extremity venous thrombosis and other complications. Methods The study group after skin closure of intra-articular injection of tranexamic acid, the control group injected with saline. Records of two groups of patients with blood loss, blood transfusion and blood transfusion rate and statistics ; check before surgery, 24 of hemoglobin （ Hb ） , packed cell volvme （PCV）, prothrombin time （ PT）, activated partial thromboplastin time （ aPTT ）, thrombin time （ T）, plasma fibrinogen（ Fbg）, platelet（PLT） ,48 h after operation by Hb, PCV, observe the changes of indexes ; check the lower extremity deep venous thrombosis （DVT） incidence, incidence of pulmonary embolism and statistics. Results Perioperative blood loss, blood transfusion and blood transfusion rate were significantly less than the control group, the difference was statistically significant （P 〈 0. 05 ） ;the study group after 24 h,48 h levels of hemoglobin and hematocrit were higher than the control group （P 〈 0.05 ） ;research group after PT, aPTT, and PLT were higher than the control group;the study group after Fbg was lower than the control group, But it fluctuates within normal range; two group DVT, pulmonary embolism complications had no significant difference （P 〉 0. 05）. Conclusion The total hip arthroplasty in the local application of tranexamic acid can reduce postoperative bleeding, and can prevent occurrence of venous thrombosis of lower extremity.