氨甲环酸联合铁剂方案减少全膝关节置换术失血的随机对照研究

Tranexamic Acid Combined with Iron in Total Knee Arthroplasty:A Prospective Randomized Controlled Study

目的本研究拟探究氨甲环酸联合蔗糖铁在全膝关节置换术中的临床效果及安全性。方法 2016年1月至2017年6月,昆明医科大学第一附属医院骨科行初次全膝关节置换患者共180例。随机分配到氨甲环酸联合铁剂组(联合组)、氨甲环酸组和铁剂组。记录置换入院时、手术前1天,手术后1、3、5d血红蛋白浓度、红细胞压积。记录术中失血量、术后引流量、术后输血患者数。同时计算术前血容量、总失血量。结果患者平均年龄65岁。所有术前基本资料,三组患者差异无统计学意义(P>0.05)。联合组和铁剂组术前血红蛋白浓度显著高于氨甲环酸组(P<0.05)。联合组术后血红蛋白浓度显著高于其他两组(P<0.05),同时,联合组术后输血、总失血量显著低于氨甲环酸组和铁剂组(P<0.05)。随访期间未出现关节感染、深静脉血栓、肺栓塞等并发症。结论氨甲环酸联和铁剂可以有效提高围术期血红蛋白浓度,减少总失血量,减少术后输血。

Objective To investigate the clinical efficacy and safety of tranexamic acid combined with sucrose iron in total knee arthroplasty（TKA）. Methods From January 2016 to June 2017,180 patients were enrolled in this study and randomly assigned to tranexamic acid combined iron group（combined group）,tranexamic acid group and iron group.Record replacement at admission,the day before surgery,after surgery,three,five days of hemoglobin concentration,hematocrit.The number of blood loss,postoperative drainage and postoperative blood transfusion were recorded.Besides,the amount of preoperative blood volume,total blood loss were recorded. Results The average age of the patients was 65 years.All preoperative data were not statistically significant（P〈0.05）.The levels of preoperative hemoglobin in combination group and iron group were significantly higher than those in group tranexamicacid group（P〈0.05）.At the same time,the blood loss and total blood loss were significantly lower in the combined group than in the group（P〈0.05）.There were no complications such as infection,deep vein thrombosis,pulmonary embolism during follow-up.Conclusion Tranexamic acid and iron can effectively improve the perioperative hemoglobin concentration,reduce the total blood loss,reduce postoperative blood transfusion.