贫血患者膝单髁置换术氨甲环酸的应用

Tranexamic acid used in unicompartmental knee arthroplasty for patients with anemia

[目的]探讨贫血患者膝单髁置换术使用氨甲环酸的临床效果。[方法]回顾性的分析2018年7月~2019年5月行单侧UKA患者术前贫血的临床资料。共有73例患者纳入本研究。按照是否使用氨甲环酸将患者分为TXA组34例,非TXA组39例。比较两组临床与辅助检查资料。[结果]两组患者均顺利手术,无严重并发症。两组在手术时间、止血带使用时间、切口长度、术中失血量的差异无统计学意义(P>0.05),但TXA术后引流量、显性失血量、隐性失血量、异体输血量显著少于非TXA组(P<0.05)。围手术期两组患者均无症状性血栓或肺栓塞。两组患者Hb和HCT术后1~3 d呈下降趋势,术后3 d均降至最低值,术后4~5 d恢复性上升(P<0.05)。术后各时间点TXA组的Hb和HCT均高于非TXA组,术后1 d时两组间差异有统计学意义(P<0.05),而术后2~5 d两组间差异无统计学意义(P>0.05)。超声检查显示,TXA组4例肌间血栓,非TXA组5例肌间血栓。[结论]静脉使用氨甲环酸可有效减少贫血患者UKA的失血量,降低输血率,而不增加深静脉血栓形成的风险。

[Objective]To investigate the clinical outcomes of tranexamic acid(TXA)used in unicompartmental knee arthroplasty(UKA)for patients with anemia.[Methods]By a retrospective analysis of patients who underwent primary unilateral UKA and suffered from anemia before operation between July 2018 and May 2019,a total 73 patients met the including criteria and were enrolled into this study.Based on whether or not TXA used in operation,34 patients fell into the TXA group,while the remaining 39 patients were in the non-TXA group.The clinical data and assistant examination documents were compared between the two groups.[Results]All patients in both group had UKA performed smoothly without serious complications.Although no statistically significant differences were noted between the two groups in operation time,tourniquet time,incision length and intraoperative blood loss(P>0.05),the TXA group proved significantly superior to the non-TXA group regarding to postoperative drainage,hidden blood loss and allotransfusion(P<0.05).No symptomatic thrombosis or pulmonary embolism happened in any patient of the two group during the perioperative period.With respect to assistant examinations,both the hemoglobin(Hb)and hematocrit(HCT)significantly varied after operation in the two groups(P<0.05),declined from 1 day to the lowest levels at 3 days and rose again to 5 days after operation.The TXA group had higher levels of Hb and HCT than the non-TXA group,which were statistically significant at 1 day(P<0.05),and became not significant from 2 days to 5 days postoperatively(P>0.05).The ultrasound scanning revealed intramuscular thrombosis in 4 patients of the TXA group,whereas 5 patients of the non-TXA group.[Conclusion]The intravenous tranexamic acid does effectively reduce the blood loss and blood transfusion in patients with anemia in UKA,without increasing the risk of deep venous thrombosis.