摘要
目的探讨抗纤溶药物氨甲环酸对全膝关节置换术出血量的影响。方法2005年6月～2006年6月,选取102例行全膝关节置换术患者。男43例,女59例;年龄59～77岁,平均68岁。病因:骨性关节炎59例,类风湿性关节炎23例,创伤性关节炎20例。病程2～12年。随机分为两组(n=51),A组在松止血带时将氨甲环酸1g稀释于250ml生理盐水后静脉点滴,3h后以相同剂量再次给药;B组仅给予等量生理盐水静脉点滴。记录术中及术后失血量和输血量,观察患者是否出现下肢深静脉栓塞的临床症状;术前、术中松止血带时和术后3h检查D二聚体(D-dimeride,D-dimer)、纤维蛋白原(fibrinogen,FIB)、凝血酶原时间(prothrombin time,PT)和活化的部分凝血活酶时间(activated partial throm boplastin time,APPT)。结果A组和B组术中出血量分别为256±149ml和306±214ml(P>0.05);术后引流量分别为478±172ml和814±156ml,总失血量分别为559±159ml和1208±243ml,差异均有统计学意义(P<0.05)。A、B组的输血量分别为556±174ml和1024±278ml(P<0.05);术后连续复查血红蛋白浓度,B组为0.6～0.8g/dl,低于A组的1.0～1.1g/dl。术后获随访6～12个月,经血管超声多普勒检查均未发现下肢深静脉血栓形成。A、B组术后3hD-dimer分别为0.92±0.56、1.32±0.79mg/L,明显高于术前的0.35±0.13、0.37±0.21mg/L,且B组显著高于A组,差异均有统计学意义(P<0.05)。两组间FIB、PT和APPT比较差异无统计学意义(P>0.05)。结论在全膝关节置换术中及术后短期使用氨甲环酸能明显减少患者失血量及输血量,并且不增加静脉血栓形成的风险。
Objective To investigate an effect of tranexamic acid on blood loss associated with total knee arthroplasty （TKA）. Methods From June 2005 to June 2006, 102 patients （43 males, 59 females aged 59-77 years, averaged 68 years） underwent TKA. Of the 102 patients, 59 had osteoarthritis, 23 had rheumatoid arthritis, and 20 had traumatic arthritis. The illness course ranged from 2 to 12 years. They were randomized divided into Group A and Group B of 51 patients each. The patients in Group A received tranexamic acid, and the patients in Group B received an equal volume of normal saline. In Group A, 1 g of tranexamic acid dissolved in 250 ml of normal saline was intravenously infused before deflation of the tourniquet ; another intravenous administration of the same drug of the same dosage was given 3 hours later. In Group B, only 250 ml of normal saline was infused intravenously. The amounts of blood loss and blood transfusion during operation and after operation in all the 102 patients were recorded. They were also observed for whether they had deep vein thrombosis. D-dimeride, fibrinogen, prothrombin time, and activated partial thromboplastin time were also examined before operation, during operation （deflation of the tourniquet）, and 3 hours after operation. Results The blood loss was 256±149 ml in Group A and 306±214 ml in Group B during operation there was no significant difference between the two groups（P〉0.05）. The postoperative drainage volume was 478±172 ml in Group A and 814±156 ml in Group B, and the total blood loss was 559±159 ml in Group A and 1 208±243 ml in Group B; there were significant differences between the two groups （P〈0.05）. The averaged amount of blood transfusion was 556±174 ml in Group A and 1 024±278 ml in Group B; there was a significant difference between the two groups （P〈 0. 05）. The postoperative hemoglobin concentration was higher in Group A than that in Group B （1.0-1.1 g/dL vs. 0.6-0.8 g/dL）. The postoperative follow-up for 6-12 months revealed that no deep vein thrombosis was found in both lower limbs of the patients by the color Doppler ultrasonography. The level of D-dimeride was significantly higher 3 hours after operation than before operation （0. 92±0.56 mg/L vs. 0. 35±0.13 mg/L in Group A; 1.32±0. 79 mg/L vs. 0. 37±0.21 mg/L in Group B） （P〈0.05）. The D-dimeride level 3 hours after operation was significantly higher in Group B than in Group A（P〈0.05）. There were no significant differences in the levels of fibrinogen, prothrombin time,.and activated partial thromboplastin time between the two groups（P〉0.05）. Conclusion During and after the TKA operation, a short-term use of tranexamic acid can significantly decrease blood loss and blood transfusion with no increasing risk for venous thrombosis.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2007年第12期1302-1304,共3页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
全膝关节置换术
氨甲环酸
对比研究
Total knee arthroplasty Tranexamic acid Comparative study
