多剂量静脉联合局部应用氨甲环酸对初次全膝关节置换术止血效果的临床研究

The Clinical Research of the Effect of Haemostasis of Multiple Doses Intravenous Combine Topical Administration of Tranexamic Acid in Primary Total Knee Arthroplasty

氨甲环酸(tranexamic acid,TXA)作为抗纤溶抑制剂可以减少出血现已广泛应用于全膝关节置换术(total knee arthroplasty,TKA)。为了观察多剂量静脉联合局部应用TXA的安全性及有效性。采用回顾性分析,选取接受初次单侧TKA的175例骨性关节炎的患者。将患者分为4组,第1组关节囊关闭后关节腔灌注1 g TXA;第2组止血带加压前静脉应用1 g氨甲环酸;第3组止血带加压前、松止血带后静脉各输注1 g TXA;第4组在止血带加压前、松止血带后、第二次剂量后3 min静脉各输注1 g TXA,关节囊关闭后关节腔灌注1 g TXA。比较各组的血红蛋白下降值、总失血量、隐性失血量、引流量、输血率,深静脉血栓、肺栓塞发生率。结果显示:多剂量静脉联合局部组患者血红蛋白下降值、总失血量、引流量、隐性失血量均低于其余三组,差异有统计学意义(P<0.05)。多剂量静脉联合局部组术后无输血患者,优于其余三组,差异有统计学意义(P<0.05)。四组术后均无深静脉血栓事件发生。研究结果表明,多剂量静脉联合局部应用TXA是安全有效的。

Tranexamic acid(TXA)as antifibrinolytic inhibitor reduces bleeding has widely used in total knee arthroplasty(TKA).In order to research the safety and effectiveness of the multiple doses intravenous combined topical administration of TXA,a total of 175 patients who underwent primary unilateral total knee arthroplasty for osteoarthritis were investigated retrospectively.The patients were divided into 4 groups:Group 1(TOP)intra-articular injection of 1 g TXA diluted in 50 mL saline after capsule closed,Group 2(V1)1 g of IV TXA prior to tourniquet inflation;Group 3(V2)1 g of IV TXA prior to tourniquet inflation,1 g of IV TXA after tourniquet deflation;Group 4(COMB)1 g of IV TXA prior to tourniquet inflation,1 g of IV TXA after tourniquet deflation,1 g of IV TXA after 3 h of the second dose administration,1 g of topical TXA at closure.Compared the maximum hemoglobin drop,the total blood lose(TBL),hidden blood lose(HBL),blood lose to drain,transfusion rate,the incidence of deep vein thrombosis(DVT)and pulmonary thromboembolism(PTE)of the 4 groups.The results show that the maximum hemoglobin drop,TBL,HBL,blood lose to drain of patients who received multiple doses IV and topical TXA were lower than the other 3 groups which had statistically significant differences(P<0.05).Patients who received multiple doses IV combined topical TXA have no transfusion occurred,which was better than the other 3 groups,with statistically significant differences(P<0.05).There was no episode of DVT and PTE occurred in any group after surgery.The results show that the use of multiple doses IV and topical TXA is safe and effective.