氨甲环酸减少一期全膝关节翻修术失血的有效性及安全性研究

Pilot study of tranexamic acid reducing blood loss in perioperative period of one-stage revision total knee arthroplasty

目的探讨氨甲环酸减少一期全膝关节翻修术失血的有效性及安全性。方法将2014年8月至2015年9月在我院行一期全膝关节翻修手术的22例病人随机分为研究组(11例)和对照组(11例)。研究组在切皮之前将1.0 g氨甲环酸稀释于100 ml生理盐水后静脉滴注;对照组仅使用100 ml生理盐水静脉滴注。术后观察比较两组病人的血液和生化检查结果、出血及输血情况以及下肢深静脉血栓形成(DVT)的发生情况。结果两组病人术前的血红蛋白(HGB)、红细胞比容(HCT)比较,差异均无统计学意义(均P>0.05);研究组病人术后第3、5天的HGB和HCT均显著高于对照组,差异均有统计学意义(均P<0.05)。两组病人术中出血量的差异无统计学意义(P>0.05);研究组和对照组的术后输血量分别为(225.5±161.7)ml和(676.1±214.8)ml,总出血量分别为(1 650.1±589.3)ml和(2 469.2±684.6)ml,差异均有统计学意义(均P<0.05)。术后复查双下肢动静脉彩超,两组病人均未见DVT发生。结论一期全膝关节翻修术术前静脉滴注氨甲环酸能有效减少术中、术后出血量与输血量,有利于术后快速康复,且不明显增加术后血栓等并发症,建议在全膝关节翻修术中推广应用。

Objective To evaluate the efficacy and safety of using tranexamic acid to reduce the blood loss in patients who undergo one?stage revision total knee arthroplasty during the perioperative period.Methods Twenty?two cases who were scheduled to undergo one?stage revision total knee arthroplasty were randomly divided into treatment group (n=11) and control group (n=11). The treatment group was intravenouslygiven 1.0 g of tranexamic acid solved in 100 ml normal saline before the surgery, while the control group wasgiven equivalent saline for instead. We compared data from two groups in terms of perioperative blood loss,blood transfusion and complications. Results There was no significant difference between two groups in thehemoglobin (HGB) and hematocrit (HCT) before operation, but at 3rd, and 5th day after operation, HGB andHCT in the treatment group were significantly increased as compared with those in the control group (P<0.05).There were no significant differences in intraoperative blood loss (P>0.05). The amount of postoperative bloodtransfusion in both two groups were (225.5±161.7) and (676.1±214.8) ml, which was significantly different(P<0.05). Total perioperative blood loss in both two groups was (1 650.1±589.3) and (2 469.2±684.6) ml,which was also significantly different (P<0.05). No deep venous thrombosis was observed through the colorDoppler flow imaging. Conclusion The intravenous use of tranexamic acid before operation could signifi?cantly reduce the blood loss and blood transfusion, without increasing the risk of deep?vein thrombosis and pulmonary embolism in the perioperative period of one?stage revision total knee arthroplasty, which was an efficacy and safety way to reduce the blood loss.