摘要
目的探讨在全膝关节置换中使用氨甲环酸对降低患者围术期失血量的有效性,以及对术后D-二聚体和纤维蛋白原的影响。方法前瞻性选择2016年12月至2017年11月在本院因终末期膝关节病行初次单侧全膝关节置换的患者,随机分为两组:观察组于手术开始前1 h及手术结束松止血带前各静脉输注氨甲环酸15 mg/kg;对照组则使用同量生理盐水替代。记录术前、术后第3天患者的血红蛋白、红细胞比容,以及术后引流量、输血量,并动态监测置换前及置换后第1、3、7、14天的D-二聚体和纤维蛋白原,观察患者是否出现下肢深静脉血栓的临床症状,并于术前、术后第14天进行下肢血管多普勒检查。结果观察组引流量、总失血量均明显少于对照组(P<0.O1,<0.05),观察组异体输血量、自体回输血量和术后总输血量均明显少于对照组(P<0.01)。两组患者输注异体血比例为观察组14.6%(6/41)、对照组38.1%(16/42,P<0.01)。观察组术后第1、3天D-二聚体均明显低于对照组(P<0.05);术后第7、14天两组间差异减小,无统计学意义(P>0.05)。各时间点纤维蛋白原两组间比较差异均无统计学意义(P>0.05)。所有入组患者术后14 d内均无下肢深静脉血栓形成。结论在全膝关节置换中使用氨甲环酸可减少术后引流量、总失血量、输血量,且不增加深静脉血栓事件的风险,但术后早期可影响D-二聚体水平,因而影响其对深静脉血栓事件预警的价值。
Objective To investigate the effects of tranexamic acid （TXA） on perioperative blood loss, D-Dimer and fibrinogen （FIB） in total knee arthroplasty （TKA）. Methods A prospective study, from December 2016 to November 2017 patients with end-stage knee osteoarthritis underwent unilateral TKA were randomly divided into two groups. Patients in treatment group received two doses of 15 mg/kg TXA by intravenous infusion 1 hour pre-operation and before the release of tourniquet; the control group was replaced with the same amount of saline. The preoperative and 3 days post-operation hemoglobin, hematocrit value, drainage, blood transfusion were recorded. The D-Dimer and FIB were dynamically monitored before operation and 1, 3, 7, 14 d after the operation. And there were also observations for whether they had deep vein thrombosis and both lower limbs of all patients were examined by the color Doppler uhrasonography 14 days after operation. Results The drainage and the total blood loss in treatment group was significantly less than in control group （P 〈0. 01, P 〈 0. 05 ）. The volume of both allogeneic and autologous blood transfu- sion in treatment group were significantly less than those in the control group （P 〈 0. 01 ）. The ratio of aiiogenie blood transfusion was 14. 6% （6/41） in treatment group, 38. 1% （16/42） in control group （P 〈 0. 01 ）. D-dimer at 1, 3d post-operation in treatment group was significantly lower than that in the control group （ P 〈 0. 05 ）, but the difference was getting smaller at 7, 14d post-operation （ P 〉 0. 05 ）. FIB at any time point between the two groups was no significant difference （ P 〉 0. 05 ）. There was no symptomatic deep venous thrombosis （DVT） in all of the three groups within 14 days. Conclusions The TXA infused intravenous can significantly decrease drainage, the total blood loss and blood transfusion without increasing risk for DVT in TKA. but early post-operation TXA could affect the level of D-dimer, thus affecting the value of early warning of DVT.
作者
王振威
李洪川
于方
姚琦
Wang Zhenwei, Li Hongchuan, Yu Fang, Yao Qi(Department of Orthopedics, Beijing Shifitan Hospital, Belting 100038, Chin)
出处
《中国医师杂志》
CAS
2018年第3期335-338,共4页
Journal of Chinese Physician
基金
北京市科委课题(Z151100003915094)
中国医师协会课题(2015-A35)~~
