摘要
目的研究全膝关节置换术(TKA)中局部使用氨甲环酸对出血量以及术后膝关节功能恢复的影响。方法 2013年12月至2015年8月(包含随访时间在内)关节科收入治疗的74例TKA手术患者分为两组,A组37例局部使用氨甲环酸术中止血,B组37例静脉使用氨甲环酸术中止血;对比两组患者的出血量、输血量、术后血红蛋白、纤维蛋白原、凝血功能、D-二聚体、并发症情况以及膝关节持续被动运动(CPM)最大角度。结果两组隐性失血量、术中出血量、术后24 h纤维蛋白原、凝血酶原时间、活化的部分凝血酶原时间以及D-二聚体等指标相比无显著统计学差异(P>0.05),A组术后12 h引流量、总失血量以及输血量均低于B组,术后第1、3、5 d A组血红蛋白含量均高于B组,且关节功能恢复A组术后3个月膝关节活动度、HSS功能评分、术后3 d CPM均高于B组,组间进行比较P均<0.05,统计学差异显著。随访6个月两组均未见下肢深静脉栓塞和肺栓塞等发生。结论 TKA术中使用氨甲环酸对出血量的控制效果良好,但局部使用更佳,可显著降低出血量,减少输血量,且不影响患者凝血功能,有助于术后膝关节功能恢复,安全有效,具有较高的临床使用价值。
Objective To study the influence of local use of tranexamic acid during total knee arthroplasty（ TKA） on the amount of bleeding and postoperative knee function recovery. Methods During December 2013 and August 2015（ including follow- up time）,74 cases of patients those who received TKA treatment were studied,follow random control principle they were divided into two groups,37 cases in group A taken local use of tranexamic acid for surgery hemostasis,37 cases of group B intravenous use of tranexamic acid for intraoperative hemostasis. Bleeding,blood transfusion,postoperative hemoglobin,fibrinogen,coagulation function,D- dimer,complications and knee joint of continuous passive motion（ CPM） maximum angle of the two groups were compared. Results Hidden blood loss,intraoperative bleeding volume,postoperative 24 h fibrin,prothrombin time,activated partial thromboplastin time and D dimer index of the two groups showed no significant difference（ P〉0.05）. 12- h after the surgery,drainage,total blood loss volume and the amount of blood transfusion of group A was lower than that in group B. 1,3 and 5 days after treatment A group ＇s hemoglobin content was higher than that in group B,as well as motion of knee joint,HSS score and postoperative CPM（ P〈0.05）. No deep venous thrombosis or pulmonary embolism occurred in two groups of patients who were followed up for 6 months. Conclusions The use of tranexamic acid in TKA had good effect on bleeding volume control,what＇s more the local use of tranexamic acid can significantly reduce the amount of bleeding and control the volume of blood transfusion,and does not affect the blood coagulation function in patients,contribute to functional recovery of knee joint after operation,it is safe and effective,has high clinical value.
出处
《齐齐哈尔医学院学报》
2016年第11期1388-1391,共4页
Journal of Qiqihar Medical University
