氨甲环酸静滴联合局部应用对全膝关节置换术失血的影响及其安全性评估

Effect and Safety Assessment on Tranexamic Acid Combined Usage for Blood Loss after Total Knee Arthroplasty

目的评估氨甲环酸静滴、局部联合使用对全膝关节置换术(Total Knee Arthroplasty,TKA)后失血的影响及其安全性评。方法选取2015年12月—2016年12月行TKA手术的膝骨关节炎患者80例,随机分为2组,每组40例。氨甲环酸静滴组(静滴组)术前15 min将氨甲环酸氯化钠注射液100 mL静脉滴注;氨甲环酸静滴局部联合使用组(联合组)于手术开始前15 min将氨甲环酸氯化钠注射液100 mL静脉滴注,关闭关节腔时经引流管注入氨甲环酸30 mL;对比两组术中失血量、总失血量、显性失血量、隐性失血量、输血率、术前及术后24 h红细胞计数(RBC)、血红蛋白值(HB)、红细胞压积(HCT)、术前及术后3 h凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)。记录住院期间并发症等。结果与静滴组相比,联合组总失血量、显性失血量以及隐性失血量均少,差异具有统计意义(P<0.05);两组患者术中出血量无统计学差异,均未输血。与联合组相比,静滴组在术后24 h红细胞计数、血红蛋白、红细胞比容明显下降(P<0.05);术后3 h凝血酶原时间、活化部分凝血活酶时间两组无显著性差异(P>0.05)。结论全膝关节置换术采用氨甲环酸静滴及局部联合使用较单纯静滴使用可进一步减少出血,且不增加置换术后深静脉血栓形成的风险。

Objective Evaluate the effectiveness and safety of tranexamic acid combined usage(intravenous infusion combined with intrarticular infusion)on blood loss after total knee arthroplasty.Methods A total of 80 patients with knee osteoarthritis who underwent unilateral TKA surgery in our hospital from December 2015 to December 2016 were randomly divided into two groups(n=40).The tranexamic acid intravenous infusion group(IV group)was given tranexamic acid 100ml intravenously 15 min before surgery;The combine group was given tranexamic acid 100ml intravenously 15 min before surgery and 30 ml locally when the capsule was closed via drainage.Intra-operative blood loss,total blood loss,evident blood loss,hidden blood loss,transfusion rate,pre and post-operative erythrocyte count,hemoglobin,hematokrit were recorded,pre and post-operative prothrombin time,activated partial thromboplastin time and relative complications were recorded.Results Compared with the intravenous drip group,the total blood loss,dominant blood loss,and latent blood loss in the combined group were all statistically significant(P<0.05).There was no statistical difference in blood loss between the two groups.No blood was transfused..Compared with the combination group,the red blood cell count,hemoglobin,and hematocrit decreased significantly in the intravenous drip group at 24 h postoperatively(P<0.05);there was no significant difference in prothrombin time and activated partial thromboplastin time at 3 h postoperatively(P>0.05).Conclusion Combined usage of tranexamic acid would reduce blood loss compare to intravenous infusion tranexamic acid during TKA,without any complications.