HIV感染全髋关节置换中应用氨甲环酸的意义

Significance of tranexamic acid used in total hip arthroplasty with HIV infection

[目的]探讨氨甲环酸(tranexamic acid,TXA)应用在HIV感染者全髋关节置换的意义。[方法]回顾性分析2010年11月—2020年9月在本院接受全髋关节置换的59例HIV感染合并股骨头坏死男性患者的临床资料,TXA组31例,无TXA组28例。比较两组临床和辅助检查结果。[结果]两组手术时间、切口长度的差异均无统计学意义(P>0.05),但是,TXA组失血量(包括总失血量、显性失血量及隐性失血量)、术后输血率、切口愈合等级、住院时间和完全负重活动时间均显著优于无TXA组(P<0.05)。术前及术后3 d,两组间下肢肌间静脉血栓阳性率的差异无统计学意义(P>0.05)。实验室检验方面,术后1、3 d,TXA组Hb、Hct显著优于无TXA组(P<0.05),术后3、7 d TXA组CRP,术后7 d ESR、DD均显著低于无TXA组(P<0.05)。[结论]TXA在HIV感染者全髋关节置换中可减少围手术期失血和切口并发症,不增加静脉血栓的发生率,是一种安全有效的辅助药物。

[Objective]To explore the significance of tranexamic acid(TXA)used in total hip arthroplasty(THA)with HIV infection.[Methods]A total of 59 male patients who underwent primary unilateral THA for femoral head necrosis complicated with HIV infection from November 2010 to September 2020 were enrolled into this study.Of them,31 patients had TXA used,while the remaining 28 patients had no TXA applied.The documents regarding to perioperative clinical consequences,laboratory test and color ultrasound examination were compared between the two groups.[Results]Although there was no significant difference in operation time and incision length between the two groups(P>0.05),the TXA group proved significantly superior to the non-TXA group in terms of blood loss,including total blood loss,dominant blood loss,recessive blood loss,blood transfusion rate,incision healing grade,hospital stay and the time to resume full weight-bearing activity(P<0.05).Ultrasonographically,there was no significant difference in intermuscular vein thrombosis found between the two groups before and 3 days after operation(P>0.05).In terms of laboratory test,Hb and Hct in the TXA group were significantly higher than those in the non-TXA group 1 and 3 days postoperatively(P<0.05),in addition,the CRP at 3 and 7 days after operation,ESR and DD 7 days postoperatively in TXA group were significantly lower than those in non-TXA group(P<0.05).[Conclusion]TXA is a safe and effective adjunctive drug used for THA of HIV patients,which can reduce perioperative blood loss and incision complications without increasing the incidence of venous thrombosis.