氨甲环酸对老年全膝关节置换术患者术后输血率、输血量、隐性失血及膝关节功能恢复的影响

Effects of Tranexamic Acid on Postoperative Transfusion Rate,Blood Transfusion Volume,Occult Blood Loss and Knee Joint Function Recovery in Elderly Patients Undergoing Total Knee Arthroplasty

目的:探讨氨甲环酸(tranexamic acid,TA)对老年全膝关节置换术(total knee arthroplasty,TKA)患者术后输血率、输血量、隐性失血及膝关节功能恢复的影响.方法:选取2017年9月至2019年2月重庆市长寿区人民医院收治的拟行TKA的老年患者218例,根据随机数字表法分为TA组和对照组,每组109例.对照组患者于切口闭合前静脉滴注0.9%氯化钠注射液治疗,TA组患者于切口闭合前静脉滴注TA 15 mg/kg治疗.观察两组患者的术中输血率、输血量及失血量,术后失血量、隐性失血量,术前及术后1、7 d的血红蛋白(Hb)、红细胞计数(RBC)水平,术前和术后2、7及14 d的纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、D-二聚体(D-D)及凝血酶时间(TT)水平;比较两组患者术前和术后2、7及14 d的视觉模拟评分(visual analogue scale,VAS)、关节周径及并发症发生情况的差异.结果:TA组患者的输血率明显低于对照组[27.52%(30/109)vs.50.46%(55/109)],差异有统计学意义(P<0.001);TA组患者的输血量明显低于对照组[(335.31±119.97)U vs.(422.69±115.82)U],差异有统计学意义(P<0.001);TA组患者术后失血量、隐性失血量明显低于对照组,差异均有统计学意义(P=0.001、P<0.001).术后1、7 d,TA组患者Hb、RBC明显高于对照组;术后7、14 d,TA组患者FIB水平明显高于对照组,PT、APTT、D-D及TT水平明显低于对照组,上述差异均有统计学意义(P<0.05).术后7、14 d,TA组患者VAS评分、关节周径明显低于对照组,差异均有统计学意义(P<0.05).两组患者皮下瘀斑紫绀、深静脉血栓发生率的差异均无统计学意义(P>0.05).结论:TA可降低TKA老年患者的输血率、输血量与隐性失血,促进膝关节功能恢复.

OBJECTIVE:To probe into the effects of tranexamic acid(TA)on postoperative transfusion rate,blood transfusion volume,occult blood loss and knee joint function recovery in elderly patients undergoing total knee arthroplasty(TKA).METHODS:Totally 218 elderly patients undergoing TKA in People’s Hospital of Chongqing Changshou from Sept.2017 to Feb.2019 were extracted to be divided into the TA group and the control group via the random number table,with 109 cases in each group.Patients in the control group were treated with 0.9%sodium chloride injection intravenously before the incision was closed,while the TA group were treated with TA 15 mg/kg intravenously before the incision was closed.Intraoperative blood transfusion rate,blood transfusion volume and blood loss volume,postoperative blood loss volume and recessive blood loss,hemoglobin(Hb)and red blood cell count(RBC)levels before surgery and after surgery of 1 d and 7 d,fibrinogen(FIB),prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer(D-D)and thrombin time(TT)before surgery and after surgery of 2 d,7 d and 14 d in two groups were observed.Differences of visual analogue scale(VAS),joint circumference and complications of two groups were compared.RESULTS:The transfusion rate of patients in the TA group was significantly lower than that in the control group[27.52%(30/109)vs.50.46%(55/109)],and the difference was statistically significant(P<0.001).The blood transfusion volume of the TA group was significantly lower than that of the control group[(335.31±119.97)U vs.(422.69±115.82)U],and the difference was statistically significant(P<0.001).Postoperative blood loss and recessive blood loss in the TA group were significantly lower than those in the control group,and the differences were statistically significant(P=0.001,P<0.001).After surgery of 1 d and 7 d,Hb and RBC in the TA group were significantly higher than those in the control group;after surgery of 7 d and 14 d,the level of FIB in the TA group was significantly higher than that in the control group,and the levels of PT,APTT,D-D and TT were significantly lower than those of the control group,the differences were statistically significant(P<0.05).After surgery of 7 d and 14 d,the VAS score and joint circumference in the TA group were significantly lower than those in the control group,the differences were statistically significant(P<0.05).There were no significant differences in the incidence of cyanosis in subcutaneous ecchymosis and deep vein thrombosis between two groups(P>0.05).CONCLUSIONS:TA can reduce the transfusion rate,transfusion volume and recessive blood loss in elderly patients with TKA,and promote the recovery of knee joint function.