氨甲环酸减少强直性脊柱炎患者初次全髋关节置换围手术期失血的疗效分析

Clinical curative effect of tranexamic acid on perioperative blood loss in primary total hip arthroplasty among patients with ankylosis spondylitis

目的探讨强直性脊柱炎患者接受单侧初次全髋关节置换围手术期使用氨甲环酸止血的有效性和安全性。方法采用前瞻性研究方法，选择2015年5月一2017年8月在首都医科大学附属北京友谊医院骨科接受单侧初次全髋关节置换术的50例强直性脊柱炎患者的临床资料，采用随机数字表法将50例患者分为观察组（n=25）和对照组（n=25）。观察组患者在切皮前10min使用15mg／kg氨甲环酸加入到250ml0．9％氯化钠溶液中静脉滴注，缝合关节囊后局部注射1．0g氨甲环酸原液；对照组患者同样时间给予250ml0．9％氯化钠溶液静脉滴注和10ml0．9％氯化钠溶液局部注射。比较两组患者术后显性失血量、隐性失血量、血红蛋白值、红细胞比容、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。计量资料以均数±标准差（露±S）的形式表示，组问比较采用t检验，计数资料以百分比（％）表示，组间比较采用x。检验。结果观察组患者术后显性失血量、隐性失血量、血红蛋白值、红细胞比容、输血量及输血人数分别为（538．9±103．6）ml、（93．29±30．6）ml、（103．4±10．2）g／L、（0．31±0．04）／L、（210．4±45．7）ml、4例；对照组患者以上指标分别为（831．5±120．8）ml、（175．8±42．3）ml、（95．7±10．1）g／L、（0．26±0．03）／L、（439．8±78．1）ml、12例。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）；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。结论围手术期使用氨甲环酸能明显减少强直性脊柱炎患者单侧初次全髋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 validity and safety of application of tranexamic acid （TAX） on amount of blood loss during operative period in patients with ankylosing spondylitis who were underwent primary unilateral total hip arthroplasty. Methods The prospective study was conducted. The clinical data of 50 cases of ankylosing spondylitis who underwent unilateral primary total hip replacement at the Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University from May 2015 to August 2017 were selected. A total of 50 patients were enrolled and randomized into the study group （ n = 25 ） and control group （ n = 25 ） random number table. The patients in the study group were given 15 mg/kg TXA dissolved in 250 ml normal saline by intravenous administration at 10 minutes before incision, and intra- articular injection after close the joint capsule. The patients in the control group were given with 250 ml 0.9% saline by intravenous and 10 ml 0.9% saline by hip joint capsule injection at the the same dose instead. The amount of overt blood loss, hidden blood loss, haemoglobim level, hematocrit, the volume of blood transfusion, and number of blood transfusion were compared between two groups. The Color Doppler flow imaging of the lower limbs was performed to detect deep venous thrombosis and pulmonary embolism. Measurement data were expressed as mean ± standard deviation （ x± s）. It was expressed by t test. Count data were expressed as percentage （%）. The data were statistically analysized by X2 test between two groups. Results The amount of overt blood loss, hidden blood loss, haemoglobin level, hematocrit, blood transfusion volume and blood transfusion in the study group were （538.9 ± 103.6） ml, （93.2 ± 30.6） ml, （103.4±10.2） g/L, （0.31 ±0.04）/L, （210.4 ±45.7） ml, 4 cases. The indexes in the control group were （831.5±120.8） ml, （175.8 ±42.3） ml, （95.7±10.1） g/L, （0.26 ±0.03）/L, （439.8 ± 78.1 ） ml, and 12 cases, respectively. 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 ）. Calf muscular venous thrombosis was found in one case of observation group. No pulmonary embolism occurred in both groups. Conclusion The application of TAX can significantly decrease the amount of blood loss during operative period in patients with ankylosing spondylitis who were underwent primary unilateral total hip arthroplasty without increasing risk for deep venous thrombosis.