氨甲环酸对初次单侧全髋关节置换术隐性失血的影响分析

Analysis of tranexamic acid influence on recessive blood loss in primary unilateral total hip arthroplasty

目的探讨术中静脉使用氨甲环酸对初次单侧全髋关节置换术隐性失血的影响,以进一步指导临床工作。方法回顾性筛选、对比、分析2013年12月至2015年6月共52例于中山大学附属第一医院被诊断为股骨头缺血坏死、骨关节炎、发育性髋关节发育不良、股骨颈骨折并行初次单侧全髋关节置换术患者;排除双侧同期置换髋关节、氨甲环酸过敏、凝血功能异常等患者。其中,实验组术中静脉使用氨甲环酸,而对照组术中不静脉使用氨甲环酸,两组均为26例,采用独立样本t检验比较两组患者围手术期总失血量、显性失血量及隐性失血量等。采用卡方检验比较性别、患侧和基础疾病。结果实验组围手术期总失血量(905±348) ml低于对照组(1 113±389) ml,差异有统计学意义(t=2. 037,P <0. 05)。同样,实验组隐性失血量(261±252) ml也低于对照组(429±399) ml,差异有统计学意义(t=2. 027,P <0. 05)。而实验组显性失血量(643±313) ml与对照组(684±237) ml相似,差异无统计学意义(P> 0. 05)。两组患者性别、年龄、术前白蛋白及凝血指标等均无统计学意义(P> 0. 05)。此外,合并两组数据后围手术期总失血量与隐性失血量呈正相关,相关系数为0. 698。结论对初次单侧全髋关节置换术患者术中静脉使用氨甲环酸可安全有效减少总失血量及隐性失血量,但对显性失血量的影响有待进一步研究。

Objective To explore the influence of intraoperative intravenous tranexamic acid( TXA on the recessive blood loss of the first unilateral total hip arthroplasty( THA) to further guide clinical work.Methods From December 2013 to June 2015,52 patients who were diagnosed as osteonecrosis of the femoral( ONFN) 、osteoarthritis( OA) 、development dysplasia of the hip( DDH) 、femoral neck fracture and underwent the first unilateral THA in the first hospital affiliated to Sun Yat-sen University were retrospectively screened,compared and analyzed. The patients who underwent bilateral THA, allergic to TXA, and coagulation dysfunction were excluded. Among them,TXA was used intravenously in the experimental group,while TXA was not used intravenously in the control group. Each group were 26 cases. The independent sample t test was used to compared total blood loss,dominant blood loss and recessive blood loss during the perioperative period. The chi-square test was used to compare gender,involved side and basic diseases.Results The total blood loss during the perioperative period of the experimental group was lower than that of the control group,and the difference was statistically significant (( 905 ± 348) ml vs( 1 113 ± 389) ml,t =2. 037,P < 0. 05)The amount of recessive blood loss in the experimental group was also lower than that in the control group,and the difference was statistically significant(( 261 ± 252) ml vs( 429 ± 399) ml,t = 2. 027,P < 0. 05)The dominant blood loss in the experimental group was similar to that in the control group,and the difference was not statistically significant(( 643 ± 313) ml vs( 684 ± 237) ml,P > 0. 05)There was also no significant difference in gender,age,preoperative albumin,blood coagulation indexes between the two groups( P > 0. 05). In addition,the total amount of blood loss during perioperative period was positively correlated with the amount of recessive blood loss after combining the two groups of data,with a correlation coefficient of0. 698. Conclusion Intraoperative intravenous use of TXA in patients with the first unilateral THA can safely and effectively reduce total blood loss and recessive blood loss,but the impact on dominant blood loss needs further study.