氨甲环酸不同给药方式对全膝关节置换术术后失血量和凝血功能的影响

Effect of Tranexamic Acid Delivery Methods on Blood Loss and Coagulation Function after Total Knee Arthroplasty

目的探讨氨甲环酸不同给药方式对全膝关节置换术(TKA)术后失血量和凝血功能的影响。方法选取2012年2月至2015年2月在乐陵市中医院初次行单侧TKA的骨关节炎患者80例,采用随机数字法将患者分为A、B两组,每组40例。A组:将0.5 g氨甲环酸溶于50 mL 0.9%氯化钠注射液中,在缝合关节囊后向关节腔内注射;B组:在关闭切口前静脉滴注氨甲环酸,剂量为10 mg/kg。记录两组患者术中出血量、术后失血量、输血量、术后血红蛋白、凝血功能以及术后深静脉血栓发生率。结果两组患者术中出血量、隐性失血量比较差异无统计学意义(P>0.05)。A组患者术后12 h引流量、术后总引流量、总失血量、输血量均显著少于B组[(135.5±23.6)mL比(170.6±28.6)mL、(180.3±40.4)mL比(266.5±45.4)mL、(886.5±100.2)mL比(993.4±133.8)mL、(452.3±85.3)mL比(542.2±93.2)mL,P<0.05]。两组患者血红蛋白水平随手术后时间的延长而降低,且B组下降速度更快[(113.2±13.2)g/L、(102.2±11.3)g/L、(105.2±13.5)g/L比(104.2±15.3)g/L、(94.2±10.5)g/L、(95.8±13.2)g/L,P<0.05]。两组患者的血红蛋白水平在组间、时点间以及组间·时点间交互作用比较,差异有统计学意义(P<0.05)。两组患者术前、术后3 h纤维蛋白原、凝血酶原时间、活化部分凝血活酶时间以及D-二聚体水平比较差异均无统计学意义(P>0.05);两组患者均无深静脉血栓发生。结论局部应用氨甲环酸可有效降低骨关节炎患者TKA术后失血量,且不增加下肢深静脉血栓发生率,疗效优于静脉应用氨甲环酸。

Objective To investigate the effects of tranexamic acid delivery methods on blood loss and coagulation function after total knee arthroplasty (TKA).Methods From Feb.2012 to Feb.2015,80 ostearthritis patients who received primary TKA were divided into group A and group B according to the random number method ,40 cases in each group .0.5 g tranexamic acid dissolved in 50 mL 0.9%NaCl,group A received intraarticular injection ,and group B received intravenous drip,10 mg/kg before closing the incision .The amounts of intraoperative blood loss ,postoperative blood loss ,blood transfu-sion volume,postoperative hemoglobin ( Hb) level,coagulation function and postoperative deep venous thrombosis incidence of the two groups were recorded .Results There was no significant difference between the intraoperative blood loss ,hidden blood loss of the two groups(P>0.05); the lead discharge 12 hours after operation,total lead flow,total blood loss and blood transfusion volume of group A were significantly less than those of group B [ ( 135.5 ±23.6 ) mL vs ( 170.6 ± 28.6) mL,(180.3 ±40.4) mL vs (266.5 ±45.4) mL,(886.5 ±100.2) mL vs (993.4 ±133.8) mL,452.3 ± 85.3) mL vs (542.2 ±93.2) mL,P<0.05].The hemoglobin levels of the two groups decreased with the time prolonging after surgery,and group decreased faster [(113.2 ±13.2) g/L,(102.2 ±11.3) g/L,(105.2 ±13.5) g/L vs (104.2 ± 15.3) g/L,(94.2 ±10.5) g/L,(95.8 ±13.2) g/L,P<0.05].The hemoglobin levels of the two groups were significantly different between groups ,different time points and groups · time points ( P<0.05 ) .There were no significant differences between the fibrinogen ,prothrombin time ,actived partial thromboplastin time and D-dimer before surgery and 3 hours after&nbsp;surgery of the two groups(P>0.05).No deep vein thrombosis happened in both groups .Conclusion Topical application of tranexamic acid can effectively reduce the amount of postoperative blood loss and do not increase the incidence of deep venous thrombosis in TKA ,the curative effect of which is better than intravenous drip method .