氨甲环酸多次静脉给药在胫骨高位截骨术中的安全性与抗炎作用

To Investigate the Safety and Anti-inflammatory Effects of Tranexamic Acid on High Tibial Osteotomy

目的探讨氨甲环酸多次静脉给药在胫骨高位截骨术中的安全性和抗炎作用。方法采用临床随机对照的方法将224例符合行胫骨高位截骨术标准的患者病例纳入研究。依据氨甲环酸研究方案分为A组(112例)男58例,女54例;平均年龄(49.33±6.83)岁;切皮前10~15 min给予氨甲环酸15 mg/kg,术后3 h、6 h及9 h各再次静脉给予1 g。B组(112例)男49例,女63例;平均年龄(52.21±6.28)岁;切皮前10~15 min给予15 mg/kg氨甲环酸,3 h后静脉再给予1 g。记录并比较两组患者总失血量、术后隐性失血量、术后24h引流量、手术时间、术后3 d抗炎因子(C反应蛋白、白细胞介素-6及血沉)、静脉血栓发生率、伤口并发症及其他并发症情况。结果所有患者随访时间9个月。A组患者术后总失血量、隐性失血量和术后24 h引流量均明显低于B组,且差异有统计学意义(P<0.05)。A组患者术后1 d、3 d、5 d C反应蛋白、白细胞介素-6及血沉均低于B组,差异有统计学意义(P<0.05);A组患者术后1 d、3 d、5 d患肢周径值和瘀斑血肿发生率均低于B组,且差异有统计学意义(P<0.05);两组患术后1 d、术后2周、术后4周深静脉血栓形成发生率比较,差异均无统计学意义(P>0.05);两组患术前、术后1个月、术后3个月及手术时间比较,差异均无统计学意义(P>0.05);两组患者术后2周无呼吸系感染与肺栓塞发生,B组患者有1例泌尿系感染。结论氨甲环酸多次静脉给药在减少胫骨高位截骨术患者围手术期失血量的同时不增加静脉血栓发生率,且随着给药次数的增加具有显著的抗炎效果。

Objective To investigate the safety and anti-inflammatory effects of tranexamic acid(TXA)on high tibial osteotomy(HTO).Methods 224 patients who met the criteria for high tibial osteotomy were included in the study using a randomized controlled clinical method.112 cases were included in group A including 58 males and 54 females.The average age was(49.33±6.83)years.TXA was administered 10 to 15 minutes before dermectomy,and another 1 g was intravenously 3 h,6 h and 9 h after surgery.Group B had 112 cases,including 49 males and 63 females.The average age was(52.21±6.28)years.15 mg/kg TXA was given 10~15 min before dermectomy,and another 1 g was given intravenously 3 h later.according to the TXA study plan.All patients were followed up for 9 months.Total blood loss,postoperative recessive blood loss,postoperative drainage volume at 24 hours,operative time,anti-inflammatory factors including C-reactive protein(CRP)、interleukin 6(IL-6)and erythrocyte sedimentation rate(ESR)3 days after surgery.Incidence of venous thrombosis,wound complications,and other complications were recorded and compared between the two groups.Results All patients were followed up for 9 months.The total postoperative blood loss,the recessive blood loss and the 24 h postoperative drainage volume of patients in the A group were significantly lower than those in the B group,and the differences were significant(P<0.05).CRP,IL-6and ESR were all lower in group A than in group B at 1,3 and 5 days after surgery,and the differences were statistically significant(P<0.05).The peri-menstrual value of the affected limb and the incidence of ecchymosis hematoma in group A 1,3 and 5 days after surgery were all lower than those in group B,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of deep vein thrombosis between the two groups at 1 day,2 weeks and 4 weeks after surgery(P>0.05).There was no significant difference in WOMAC score and operation time between the two groups before surgery,1 month and 3 months after surgery(P>0.05).There was no respiratory infection or pulmonary embolism in the two groups,and there was 1 case of urinary infection in group B,two weeks after the operation.Conclusion Repeated administration of TXA reduced perioperative blood loss in patients undergoing HTO without increasing the incidence of venous thrombosis,and showed significant anti-inflammatory effects with the increase of administration times.