氨甲环酸联合术中自体血回输在THA中的应用

Application of tranexamic acid combined with intraoperative suction autologous blood transfusion in total hip arthroplasty

目的探讨氨甲环酸联合术中自体血回输在全髋关节置换术中应用的安全性及有效性和两者的治疗效果。方法2019年1月至2020年12月行初次单侧全髋关节置换术患者60例,分成3组,每组20例。A组:术中未使用氨甲环酸和术中自体血回输。B组:术中使用氨甲环酸。C组:术中使用氨甲环酸和自体血回输。通过对3组患者术前第1天、术后第1天和术后第5天的凝血酶原时间、活化部分凝血激酶时间、纤维蛋白原、D-二聚体、血红蛋白、血小板、红细胞、白细胞、C-反应蛋白、血沉数值的比较,统计术中出血量、回输血量、术后引流量、总失血量、异体输血总量、异体血输血率,记录发生下肢肌间静脉血栓、下肢深静脉血栓、肺动脉栓塞并发症的数据,分析氨甲环酸、氨甲环酸联合术中自体血回输在全髋关节置换术中应用的有效性及安全性和两者的治疗效果。结果氨甲环酸联合术中自体血回输在全髋关节置换中的应用,可以减少围手术期的出血量、术中出血量、术后引流量、异体血的总输入量和异体血输血率。结论围手术期总出血量在1000ml左右的全髋关节置换手术,采用氨甲环酸联合术中自体血回输,可使大约65%的需要异体血输血的患者避免异体血输血,有效节约血液资源,临床上值得推广应用。

Objective To investigate the safety and efficacy of tranexamic acid combined with intraoperative suction autologous blood transfusion in total hip arthroplasty and the therapeutic effect.Methods A total of 60 patients who underwent primary unilateral total hip replacement in the department of Orthopedics of our hospital from January 2019 to December 2020 were selected and divided into 3 groups with 20 patients in each group.Group A:tranexamic acid and absorption autotransfusion were not used during the operation.Group B:tranexamic acid was used intraoperatively.Group C:tranexamic acid and intraoperative absorption autotransfusion were used.The values of prothrombin time,activated partial thromkinase time,fibrinogen,D-dimer,hemoglobin,platelets,red blood cells,white blood cells,C-reactive protein and blood sedimentation rate on the first day before surgery,the first day after surgery and the fifth day after surgery,Intraoperative blood loss,backtransfusion,postoperative drainage,total blood loss,total allogeneic blood transfusion and allogeneic blood transfusion rate were counted,and the data of complications of lower extremity intermuscular venous thrombosis,deep venous thrombosis and pulmonary embolism were recorded.The efficacy and safety of tranexamic acid and tranexamic acid combined with intraoperative absorption autologous blood transfusion in total hip arthroplasty were analyzed.Results The application of tranexamic acid combined with intraoperative absorption autologous blood transfusion in total hip arthroplasty can reduce perioperative blood loss,intraoperative blood loss,postoperative drainage,total allogeneic blood input and allogeneic blood transfusion rate.Conclusion In total hip arthroplasty with perioperative total blood loss of about 1000ml,trantranic acid combined with intraoperative suction autologous blood transfusion can prevent allogeneic blood transfusion for about 65%of patients who need allogeneic blood transfusion,effectively saving blood resources,and it is worthy of clinical application.