术后追加应用氨甲环酸对类风湿性关节炎全膝关节置换术后失血量的影响

Effect of postoperative tranexamic acid on blood loss after total knee arthroplasty for rheumatoid arthritis

目的探讨术后追加应用氨甲环酸(TXA)对类风湿性关节炎(RA)全膝关节置换术(TKA)后失血量的影响。方法将初次行TKA治疗的100例RA患者随机分组为常规剂量组和术后追加剂量组,每组50例。常规剂量组于手术切皮前30 min静脉滴注及关闭关节腔后关节腔内注射TXA,追加剂量组在常规剂量组基础上于术后4 h静脉滴注TXA。记录两组患者术后第7天的RBC计数、Hb、红细胞压积、凝血功能、D-二聚体水平及膝关节疼痛视觉模拟量表(VAS)评分、美国特种外科医院(HSS)膝关节评分、下肢深静脉血栓(DVT)发生率,比较两组患者术后失血量。结果术后第7天,追加剂量组Hb水平高于常规剂量组(P<0.05),而两组PLT、凝血酶原时间、国际标准化比值、部分凝血活酶时间、D-二聚体水平及VAS评分、HSS评分、DVT发生率比较,差异均无统计学意义(均P>0.05)。追加剂量组总失血量、围术期总失血量、隐形失血量及术后需输血率均低于常规剂量组(均P<0.05)。结论术后追加应用TXA可进一步减少RA患者TKA后失血量,且不增加DVT的发生。

Objective To investigate the effect of postoperative tranexamic acid（ TXA） on blood loss after total knee arthroplasty（ TKA） for rheumatoid arthritis（ RA）. Methods A total of 100 patients with RA undergoing first TKA were randomly divided into conventional dose group and postoperative additional dose group,with 50 cases in each group. The conventional dose group was given intravenous drip of TXA at 30 minutes before skin incision as well as intra-articular injection of TXA after closing articular cavity,and the postoperative additional dose group was given intravenous drip of TXA at 4 hours after surgery on the basis of the therapy performed in the conventional dose group. On the 7 th day after operation,the levels of RBC count,Hb,hematocrit,coagulation function and D-dimer,as well as the knee Visual Analogue Scale（ VAS） score,Hospital for Special Surgery（ HSS） knee score and incidence of lower extremity deep vein thrombosis（ DVT）,were recorded,and the postoperative blood loss was compared between the two groups. Results On the 7 th day after operation,the level of Hb in the additional dose group was higher than that in the conventional dose group（ P〈 0. 05）,and there was no significant difference between the two groups in the PLT,prothrombin time,international normalized ratio,activated partial thromboplastin time,D-dimer level,VAS score,HSS score,or incidence rate of DVT（ all P〉 0. 05）. The total blood loss,total blood loss during the perioperative period,hidden blood loss,and the rate of postoperative blood transfusion in the additional dose group were lower than those in the conventional dose group（ all P 〈0. 05）. Conclusion Additional dose of TXA used after operation can further reduce the blood loss after TKA in RA patients,which does not increase the incidence of DVT.