氨甲环酸在全膝关节置换术中有效性与安全性研究进展

Research progress on the safety and efficacy of tranexamic acid in total knee arthroplasty

氨甲环酸(Tranexamic acid, TXA)为临床上一种常用的止血药物,能够明显降低如创伤、手术等出血所造成的死亡风险。氨甲环酸通过可逆结合纤溶酶原上的4~5个赖氨酸受体位点,起到抗纤维蛋白溶解作用,从而减少纤溶酶原向纤溶酶的转化,防止纤维蛋白降解,并保留纤维蛋白基质的结构框架,进而达到止血的作用。近年来,有文献报告氨甲环酸用于全膝关节置换术可降低围手术期出血风险,减少输血率的同时可降低输血相关的并发症。同时,氨甲环酸可减少患者术后隐性失血,缓解患肢肿胀及疼痛的同时改善瘀斑,促进创面的愈合进而加快患者关节功能的恢复。然而,不同的研究对氨甲环酸应用于全膝关节置换术的给药方式和给药剂量及安全性存在差异。因此,本文对氨甲环酸在全膝关节置换术中有效性与安全性文献进行了复习并做一简要综述。

Tranexamic acid(TXA) is generally applied in hemostatic drug in clinic, which can significantly reduce the risk of death caused by bleeding such as trauma and surgery. TXA plays an anti fibrinolysis role by reversibly binding 4 ~ 5 lysine receptor sites on plasminogen, so as to reduce the transformation from plasminogen to plasmin, prevent fibrin degradation, and retain the framework of fibrin matrix structure, thereby achieving hemostasis. In recent years, it has been reported that TXA used in total knee arthroplasty can reduce the risk of perioperative bleeding, reduce blood transfusion rate and blood transfusion related complications. At the same time, TXA can reduce the occult blood loss after operation, alleviate the swelling and pain of affected limbs, improve ecchymosis, promote wound healing, and then accelerate the recovery of joint function. However, there are differences in the administration mode, dosage and safety of TXA in total knee arthroplasty among different studies. Therefore, this paper reviews the literature on the efficacy and safety of TXA in total knee arthroplasty.