氨甲环酸联合云南白药减少全髋关节置换术失血量的对照研究

A comparative study of tranexamic acid and Yunnan Baiyao on reducing blood loss in total hip arthroplasty

目的观察氨甲环酸联合云南白药减少全髋关节置换术失血量的效果。方法纳入自2015-04—2017-05完成的60例全髋关节置换术,按随机数字表法分为2组(各30例),观察组联合应用氨甲环酸与云南白药,对照组单纯应用氨甲环酸。比较2组术中输血量、失血量(隐性失血量、显性失血量、总失血量)、术后24 h引流量,以及术后1、4、7 d血红蛋白与红细胞压积。结果观察组术中输血量、隐性失血量、显性失血量、总失血量、术后24 h引流量均少于对照组,差异有统计学意义(P<0.05)。观察组术后1、4、7 d血红蛋白与红细胞压积均高于对照组,差异有统计学意义(P<0.05)。观察组术后出现2例肺炎,对照组出现2例肺炎、1例创面水肿、1例切口感染,对症处理后痊愈。结论全髋关节置换术中应用氨甲环酸联合手术前后口服云南白药胶囊减少术中出血量以及术后引流量的效果较单一应用氨甲环酸的治疗效果更优,能减少红细胞压积、血红蛋白水平的波动,更有利于患者早期恢复。

Objective To observe the effect of tranexamic acid combined with Yunnan Baiyao on bleeding volume in total hip arthroplasty. Methods Sixty patients with total hip arthroplasty in our hospital from April 2015 to May 2017 were selected, and they were divided into two groups by random number table, 30 cases in each group. Observation group was given tranexamie acid combined with Yunnan Baiyao capsules, while control group was purely treated with tranexamic acid. The volume of blood transfusion, blood loss （recessive blood loss, dominant loss of blood, total blood loss）, the drainage volume 24 h after operation, and hemoglobin and hematocrit at 1, 4, 7 d after operation were compared between the two groups. Results In the observation group, the amount of blood transfusion, recessive blood loss, dominant blood loss, total blood loss, the drainage volume 24 h after operation were less than those in the control group, the difference was statistically significant （P 〈 0.05）. Hemoglobin and hematocrit at 1, 4 and 7 d after operation in the observation group were higher than those in the control group （P 〈0.05）. There were 2 pneumonia cases in the observation group while in the control group there were 2 cases of pneumonia, 1 case of edema of the wound, 1 case of wound infection, and all recovered after symptomatic treatment. Conclusion The effect of tranexamic acid combined with Yunnan Baiyao capsules to reduce the amount of bleeding and the flow rate after total hip arthroplasty is better than that of purely with tranexamic acid, which can reduce the fluctuation of hematocrit and hemoglobin level, and is more beneficial to the early recovery of the patients.