氨甲环酸对类风湿关节炎患者全髋关节置换围术期失血的影响

The effects oftranexamic acid on bleeding in patients with rheumatoid arthritis following total hip arthroplasty

目的:研究氨甲环酸对类风湿关节炎患者全髋关节置换围术期失血的影响。方法:回顾性分析我院2013年4月至2015年7月期间157例因类风湿关节炎(steinbrocker 3、4级)行初次全髋关节置换术患者的临床资料,其中对照组40例未使用氨甲环酸,单次给药组56例在术前20 min静脉滴注氨甲环酸15 mg·kg^(-1),重复给药组61例在单次给药组基础上于术后3 h再次静脉滴注氨甲环酸10 mg·kg^(-1)。比较3组术后总失血量、输血率、深静脉血栓、肺栓塞发生率、凝血指标、术后引流量、术后血红蛋白下降值及并发症情况。结果:与对照组比较,重复给药组和单次给药组总失血量、术后引流量及术后第3天血红蛋白减少值均显著变小,差异具有统计学意义(均P<0.05);与单次给药组比较,重复给药组术后总失血量、引流量及术后第3天血红蛋白减少值均进一步减小,差异具有统计学意义(均P<0.05)。重复给药组术后输血率明显低于对照组(P<0.05)。术后3组患者均未发生深静脉血栓及肺栓塞,且术后凝血指标组间比较均无显著差异(均P>0.05)。单次给药组7例、重复给药组5例、对照组6例出现切口并发症,组间比较差异无统计学意义(P>0.05)。结论:氨甲环酸静脉滴注可有效降低类风湿关节炎患者全髋关节置换围术期总失血量与输血率,且不增加血栓及并发症的发生。另外,术前及术后3 h重复给药作用优于术前单次使用氨甲环酸。

Objective:To study the effects of tranexamic acid on bleeding in patients with rheumatoid arthritis(R A)following total hip arthroplasty(TH A).M eth od s:The clinical data of157RA patients(steinbrocker3=)from our hosj)ital following primary unilateral THA from A p ril,2013to July,2015were analyzed retrospectively.The patients were divided into three groups based on the regimen of tranexamic acid:40cases didn’t amic acid(control group),56cases received a single intravenous dosage of15mg.kg1tranexamic acid20minprior to operation!single group),61cases received an intravenous dosage of15mg-k g_1preoperatively and a seconddosage of10mg-k g_13hours postoperatively(repeated group).The outcomes including total blood loss,transfusion rate,the incidence of deep vein thrombosis(DV T),and pulmonary embolism(PE),postoperativedrainage,coagulative function index,postoperative hemoglobin(H b)decline on third day postoperatively wound related complications in different groups were compared.R esults:There were less total blood drainage and Hb decline in single drug group and repeated drug group when compared with control group(all!<0.05).And the effects were better in repeated druggroup than that in single group(all!<0.05).Comparedwith control group,the rate of transfusion requirement in repeated drug group became lower significantly(p<0.05).No episode of DVT or PE occurred in three groups.Comparison of postoperative coagulative function indexamong three groups had no significant differences,respectively(allP>0.05).There were7wound in sigle group,5in repeated group,and6in control group,and there were no statistical differences(p>0.05).C onclusion:Intravenous administration of tranexamic acid is effective and safe on decreasing blood requirement in RA patients following THA.Compared witli a single dosage of tranexamic acid preoperatively,a second dosage of tranexamic acid3hours postoperatively can be recommended.