摘要
背景:初次单侧全髋关节置换术(THA)后口服氨甲环酸的合适时间和剂量尚不清楚,缺乏高质量的随机对照研究。目的:探讨加速康复流程下THA围手术期多次口服氨甲环酸对减少失血的有效性和安全性。方法:将2017年1月至2017年6月行初次单侧THA的97例患者随机分为试验组(49例)和对照组(48例)。两组切皮前5~10 min均静脉滴注氨甲环酸20ml/kg;术后4h、10h、16h试验组患者分别口服氨甲环酸2g(4片),对照组口服相同剂量的安慰剂。结果:试验组围手术期总失血量和隐性失血量均明显少于对照组[(681.7±256.1)ml vs(1001.7±443.7)ml,(583.8±261.4)ml vs(786.4±486.7)ml],试验组术后住院时间更短[(2.3±0.5)d vs(4.9±1.8)d],差异均有统计学意义(P<0.001,P=0.020,P<0.001)。试验组3例、对照组2例患者出现肌间静脉血栓,但差异无统计学意义(P>0.05)。两组均未发生深静脉血栓、肺栓塞和深层感染。结论:围术期多次口服氨甲环酸可显著降低患者的失血量、血红蛋白和血细胞比容下降量,缩短术后住院时间,且不增加并发症的发生率。
Background:The appropriate time and dose of oral tranexamic acid(TXA)following primary total hip arthroplasty(THA)are still unclear,and it lacks of high-quality random controlled trials.Objective:To evaluate the effectiveness and safety of multiple boluses of oral TXA to reduce blood loss in primary THA under enhanced recovery process.Methods:A total of97 patients undergoing primary THA from January 2017 to June 2017 were randomized into experimental group(n=49)and control group(n=49).All the patients received intravenous TXA(20 mg/kg)5-10 min before skin incision.In the experimental group,3 doses of 2 g oral TXA were given at 4 h,10 h and 16 h postoperatively.In the control group,3 doses of placebo were given at the same time points.The total blood loss,hidden blood loss,length of hospital stay,hemoglobin and hematocrit drop and complications were compared between groups.Results:The total blood loss and hidden blood loss in the experimental group were significantly less than those in control group([681.7±256.1]ml vs[1001.7±443.7]ml,P<0.001;[583.8±261.4]ml vs[786.4±486.7]ml,P=0.020).The length of hospital stay of experimental group was shorter than that in control group([2.3±0.5]dvs[4.9±1.8]d,P<0.001).Calf muscular vein thrombosis developed in 3 patients of experimental group and 2 patients of control group.No deep venous thrombosis,pulmonary embolism or deep infection were found.Conclusions:Multiple boluses of oral TXA are effective on reducing blood loss,length of hospital stay,hemoglobin and hematocritdrop in primary THA without increasing the risk of complications.
作者
杨秀丽
李玲利
欧阳朝威
侯晓玲
YANG Xiuli;LI Lingli;OUYANG Chaowei;HOU Xiaoling(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《中华骨与关节外科杂志》
2019年第5期337-340,共4页
Chinese Journal of Bone and Joint Surgery
基金
四川省科技厅项目(2016FZ0075)
卫生部卫生行业科研专项基金(2013020007)
