氨甲环酸治疗膝骨关节炎患者全膝关节置换术出血量的效果研究

Clinical Effect of Using Tranexamic Acid on Intraoperative and Postoperative Blood Loss in Total Knee Arthroplasty

目的探讨应用氨甲环酸(TXA)对膝骨关节炎患者全膝关节置换术(TKA)术中及术后出血量的影响。方法选取武警后勤学院附属医院2015年6—12月行单侧TKA,术中及术后不使用TXA的膝骨关节炎患者52例(常规组),以及2016年3—9月行单侧TKA,术中及术后多途径应用TXA的膝骨关节炎患者46例(TXA组)为研究对象。常规组术中及术后不使用TXA;TXA组切皮前10 min静脉滴注1 g TXA,缝合完成后自引流管注入1 g TXA,术后6、12、24 h分别静脉滴注1 g TXA。记录两组显性出血量、隐性出血量、输血率、下肢深静脉血栓(DVT)发生率。结果 TXA组显性出血量、隐性出血量分别为(224±59)、(486±69)ml,均低于常规组的(361±70)、(633±79)ml(P<0.05)。TXA组输血率为6.5%(3/46),低于常规组的46.2%(24/52)(P<0.05)。TXA组、常规组下肢DVT发生率分别为4.3%(2/46)、7.7%(4/52),差异无统计学意义(P>0.05)。结论膝骨关节炎患者局部联合静脉应用TXA可减少TKA术中及术后出血量,降低输血率,且不增加下肢DVT风险。

ObjectiveTo investigate the effect of tranexamic acid（TXA） on intraoperative and postoperative blood loss in patients with knee osteoarthritis undergoing total knee arthroplasty（TKA）.MethodsWe enrolled 98 cases of knee osteoarthritis treated by unilateral TKA from Affiliated Hospital of Logistics University of Chinese People＇s Armed Police Force,including 52 received the surgery between June and December 2015（control group） ,and 46 received the surgery between March and September 2016（TXA group）.The control group did not use TXA,while the TXA group received TXA intraoperatively and postoperatively via various ways（intravenous drip of TXA 1 g at 10 min before making a skin incision,intra-articular injection of TXA 1 g via a draining tube when the suturing was completed,and intravenous drip of TXA 1 g at 6,12 and 24 h after TKA）.We analyzed both groups＇ visible and hidden blood loss,rate of receiving blood transfusion and the incidence of lower extremity deep vein thrombosis（DVT） .ResultsCompared with the control group,TXA group showed less visible blood loss〔（224±59） ml vs（361±70） ml〕,hidden blood loss〔（486±69）ml vs（633±79）ml〕 as well as lower rate of receiving blood transfusion〔6.5%（3/46） vs 46.2%（24/52）〕（P〈0.05）.However,the incidence of lower extremity DVT in the TXA group and the control group was 4.3%（2/46） and 7.7%（4/52）,respectively,with no significant difference（P〉0.05）.ConclusionLocal application combined with intravenous drip of TXA can reduce intraoperative and postoperative blood loss and rate of receiving blood transfusion without increasing the risk of lower extremity DVT in patients with knee osteoarthritis undergoing TKA.