氨甲环酸对初次同期双侧人工全髋关节置换术的止血效果及安全性分析

Analysis of hemostatic effect and safety of tranexamic acid in primary simultaneous bilateral total hip arthroplasty

目的探讨氨甲环酸(tranexamic acid,TXA)对初次同期双侧人工全髋关节置换术(simultaneous bilateral total hip arthroplasty,SBTHA)围术期输血率、显性失血量及术后并发症的影响。方法回顾性分析2010年1月—2018年12月72例行初次SBTHA患者的临床资料。其中,48例于术前5~10 min静脉滴注TXA(15 mg/kg)(试验组),24例未使用TXA(对照组)。两组患者性别、年龄、体质量指数、疾病类型、美国麻醉医师协会(ASA)分级、合并内科疾病以及术前住院时间、血红蛋白、红细胞比容、血小板计数、凝血功能指标比较,差异均无统计学意义(P>0.05)。记录并比较两组手术时间、术中失血量以及术后输血率、引流量、显性失血量、并发症发生情况及住院时间。结果试验组手术时间中位数为208.0 min,对照组为202.5 min,差异无统计学意义(Z=-1.046,P=0.295)。术后试验组输血26例(54.2%)、对照组21例(87.5%),两组输血率差异有统计学意义(χ^2=7.843,P=0.005);但两组输注的悬浮红细胞以及血浆量比较,差异均无统计学意义(P>0.05)。试验组术中失血量中位数为550 mL、对照组为600 mL,差异无统计学意义(Z=-1.378,P=0.168)。试验组术后引流量为(542±269)mL、显性失血量中位数为1050 mL,均明显低于对照组的(710±316)、1270 mL(P<0.05)。术后试验组出现1例切口周围皮肤张力性水疱、1例一侧下肢麻木及肌力减退、1例腔隙性脑梗死,对照组出现1例切口周围皮肤瘀斑、1例双侧下肢麻木及肌力减退,并发症发生率差异均无统计学意义(P>0.05)。两组术后均未出现肺栓塞及下肢深静脉血栓形成。试验组术后住院时间及总住院时间中位数分别为9.0、13.0 d,对照组分别为9.0、13.0 d,差异均无统计学意义(P>0.05)。结论对初次SBTHA患者,使用TXA可以降低输血率及围术期显性失血量,具有良好止血作用;同时不增加切口并发症、静脉栓塞形成发生率及住院时间,具有一定安全性。

Objective To explore the effect of tranexamic acid(TXA)on the transfusion rate,dominant blood loss,and postoperative complications in simultaneous bilateral total hip arthroplasty(SBTHA).Methods A clinical data of 72 patients who underwent the primary SBTHA between January 2010 and December 2018 was retrospectively analyzed.A single dose of 15 mg/kg TXA was administered intravenously before 5-10 minutes of operation in 48 patients of trial group and 24 patients were not treated with TXA in the control group.There was no significant difference between the two groups(P>0.05)in the gender,age,body mass index,the type of disease,American Society of Anesthesiologists(ASA)grading,comorbidity,and preoperative hospital stay,hemoglobin,hematocrit,platelet count,coagulation function tests.The operation time,intraoperative blood loss,and postoperative transfusion rate,dominant blood loss,complication,and hospital stay were recorded and compared between the two groups.Results The median operation time of the trial group was 208.0 minutes,and that of the control group was 202.5 minutes,with no significant difference(Z=-1.046,P=0.295).Postoperative transfusion was performed in 26 patients(54.2%)in the trial group and 21 patients(87.5%)in the control group,and the difference of transfusion rate between the two groups was significant(χ^2=7.843,P=0.005).However,there was no significant difference in the amount of transfused suspended red blood cells and plasma between the two groups(P>0.05).The median intraoperative blood loss was 550 mL in the trial group and 600 mL in the control group,with no significant difference(Z=-1.378,P=0.168).The postoperative drainage volume and median dominant blood loss in the trial group were(542±269)and 1050 mL,respectively,which were significantly lower than those in the control group[(710±316)and 1270 mL](P<0.05).There was 1 case of skin tension blisters around the incision,1 case of lower limb numbness and muscle strength loss,and 1 case of lacunar cerebral infarction in the trial group,while in the control group,there was 1 case of skin ecchymosis around the incision and 1 case of bilateral lower limb numbness and muscle strength loss,which showed no significant difference in the incidences of complications(P>0.05).No pulmonary embolism or deep venous thrombosis was found in the two groups.The median postoperative hospital stay and median total hospital stay were 9.0 and 13.0 days in the trial group,while 9.0 and 13.0 days in the control group,respectively,with no significant difference(P>0.05).Conclusion For patients who are treated with the primary SBTHA,TXA can reduce transfusion rate and perioperative dominant blood loss,and has a good hemostatic effect without increasing complications of incision,pulmonary embolism,deep venous thrombosis,and hospital stay.Therefore,TXA is relative safe.