老年全髋关节置换术中联合应用氨甲环酸和利伐沙班的临床研究

A clinical study of combined application of tranexamic acid and rivaroxaban in total hip arthroplasty in the aged

目的:观察老年全髋关节置换术中联合应用氨甲环酸和利伐沙班的临床疗效和安全性。方法:将70例初次接受单侧全髋关节置换手术的患者随机分为2组,每组35例。由同一组医生对所有患者实施全髋关节置换术,采用全身麻醉或腰硬联合麻醉,均选用前外侧入路。术中关闭关节腔后,联合组经引流管向关节腔内注入10%氨甲环酸注射液20 mL,利伐沙班组经引流管向关节腔内注入生理盐水20 mL,夹闭6 h后打开引流管。术后6 h,联合组将适量氨甲环酸注射液(10 mg·kg^(-1))稀释于100 mL生理盐水中静脉滴注,利伐沙班组静脉滴注100 mL生理盐水。2组患者均于术后6 h开始口服利伐沙班片,每次10 mg,每天1次,共服用5周。比较2组患者的显性红细胞丢失量和隐性红细胞丢失量,同时观察术后3个月内肺栓塞发生情况及下肢深静脉血栓形成情况。结果:联合组有6例患者输血,利伐沙班组有8例患者输血。2组的输血率比较,差异无统计学意义(χ~2=0. 357,P=0. 550)。联合组的显性红细胞丢失量和隐性红细胞丢失量均低于利伐沙班组[(215. 00±42. 00) mL,(277. 00±51. 00) mL,t=5. 552,P=0. 000;(247. 00±35. 00) mL,(360. 00±43. 00) mL,t=12. 507,P=0. 000]。术后3个月内2组患者均未发生肺栓塞和下肢深静脉血栓。结论:在老年全髋关节置换手术中联合应用氨甲环酸和利伐沙班可以有效减少出血,而且短期内不会增加肺栓塞和下肢深静脉血栓形成的风险。

Objective:To observe the clinical curative effects and safety of combined application of tranexamic acid and rivaroxaban in total hip arthroplasty(THA)in the aged.Methods:Seventy patients were treated with primary unilateral THA and were randomly divided into combination group and rivaroxaban group,35 cases in each group.THA was performed through anterolateral approach by the same group of surgeons under general anesthesia or combined spinal-epidural anesthesia.After the articular cavity was closed in the sugery,10%tranexamic acid injection(20 mL)was injected into articular cavity through drainage tube in combination group,while the same dose of normal saline(NS)was injected into articular cavity through drainage tube in rivaroxaban group.The drainage tube was closed for 6 hours.At 6 hours after the surgery,the patients in combination group were treated with intravenous drip of tranexamic acid injection(10 mg/kg)dissolved in 100 mL of NS,while the patients in rivaroxaban group were treated with intravenous drip of 100 mL of NS.All patients were treated with oral application of rivaroxaban tablets since the 6th hour after the surgery,once a day,10 mg at a time for 5 consecutive weeks.The dominant erythrocyte loss and hidden erythrocyte loss were compared between the 2 groups,meanwhile,the complications such as pulmonary embolism(PE)and lower extremity deep venous thrombosis(DVT)were observed within 3 months after the surgery.Results:Blood transfusions were performed on 6 patients in combination group and 8 patients in rivaroxaban group.There was no statistical difference in the blood transfusion rate between the 2 groups(χ^2=0.357,P=0.550).The dominant erythrocyte loss and hidden erythrocyte loss were lower in combination group compared to rivaroxaban group(215.00+/-42.00 vs 277.00+/-51.00 mL,t=5.552,P=0.000;247.00+/-35.00 vs 360.00+/-43.00 mL,t=12.507,P=0.000).No PE and lower extremity DVT were found in both of the 2 groups within 3 months after surgery.Conclusion:Combined application of tranexamic acid and rivaroxaban can effectively reduce blood loss in aged patients who received THA,while the risks of PE and lower extremity DVT won't increase in short term.