氨甲环酸对不同病种初次全髋关节置换术疗效的差异

Therapeutic difference of tranexamic acid in different diseases of primary total hip arthroplasty

目的:探索不同病种对氨甲环酸在初次全髋关节置换术中疗效的影响。方法:回顾性收集2011年12月至2013年6月因终末期髋关节疾病于四川大学华西医院骨科行初次单侧全髋关节置换术的患者,其中2011年12月至2012年9月的患者均未使用氨甲环酸,2012年10月至2013年6月的患者均静脉应用氨甲环酸10 mg/kg。通过对不同病种进行分层分析比较围手术期失血量、红细胞输注率的差异,应用logistic回归分析不同病种对围手术期输血率及氨甲环酸疗效的影响。结果:共纳入827例患者,应用氨甲环酸可在不增加血栓并发症的同时有效降低围手术期总失血量(0.998L vs 1.383 L,P<0.001)及输血率(6.72%vs 20.85%,P<0.001)。Logistic回归分析结果提示围手术期输血率的危险因素包括术前血红蛋白(OR=4.284,P=0.002)、红细胞压积(OR=2.731,P=0.022)及应用氨甲环酸(OR=0.243,P<0.001),而术前诊断非围手术期输血率的危险因素(P>0.05)。分层分析提示氨甲环酸在降低各病种初次全髋关节置换术围手术期输血率方面的效果由强至弱依次为股骨头缺血性坏死(OR=0.213,P=0.001)、骨关节炎(OR=0.265,P=0.016)及发育性髋关节发育不良(OR=0.311,P=0.002)。结论:初次全髋关节置换术静脉应用10 mg/kg氨甲环酸有效且安全,虽不同病种之间的围手术期失血量及输血率存在差异,但术前诊断非围手术期输血率的危险因素。氨甲环酸在股骨头缺血性坏死患者中可获得更好的疗效。

Objective:To assess the impact of pre-arthroplasty diagnosis on the efficacy of TXA.Methods:A cohort study of patients underwent primary unilateral THA during two periods(2011 to 2012 without tranexamic acid,2012 to 2013 with 10 mg/kg tranexamic acid)was conducted.Outcomes of blood loss and red cell blood transfusion rate were compared in different subgroups according to stratified analysis of pre-arthroplasty diagnosis.And logistic regression analysis was performed to assess the effects of different diagnosis on transfusion.Results:A total of 827 patients were included.Use of TXA produced a statistical significance in total blood loss(0.998 L vs 1.383 L,P<0.001)and transfusion rate(6.72%vs 20.85%,P<0.001),with no increase of thromboembolic events.Pre-arthroplasty diagnosis was not a risk factor for postoperative transfusion(P>0.05)independent of preoperative hemoglobin(OR=4.284,P=0.002),hematocrit(OR=2.731,P=0.022)and TXA use(OR=0.243,P<0.001).In quantitative terms of transfusion,the results supported a higher efficacy in osteonecrosis of femoral head(OR=0.213,P=0.001),followed by osteoarthritis(OR=0.265,P=0.016)and development dysplasia of hip(OR=0.311,P=0.002).Conclusion:An intravenous dose of 10 mg/kg TXA was effective and safe to reduce blood loss and transfusion in patients undergoing primary total hip arthroplasty.Even the blood loss varied among disease,pre-arthroplasty diagnosis was not the risk factor for postoperative transfusion.And intravenous TXA use may produce a higher efficacy in the patients with osteonecrosis.