摘要
目的探究氨甲环酸复合注射用血凝酶对行全髋置换术的老年患者围术期出血及凝血功能的影响。方法选择2018年6月至2019年6月于内蒙古包钢医院行全髋关节置换术患者90例,年龄60~80岁,采用随机数字表法,随机分为三组,每组各30例。Ⅰ组(氨甲环酸组):术前按15 mg/kg标准将氨甲环酸稀释到20 ml,切皮即刻静脉注射,术中以15 mg/(kg·h)标准追加;Ⅱ组(注射用血凝酶组):术前按0.02 U/kg的标注将注射用血凝酶稀释到20 ml,于切皮前15 min静脉推注,术中以0.01 U/(kg·h)标准追加;Ⅲ组(氨甲环酸复合注射用血凝酶组):按Ⅰ、Ⅱ组的标准稀释给药并维持。于术前、术毕和术后6 h三个时间点测定红细胞比容(Hct)、血小板计数(Plt)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)和凝血酶时间(TT)。结果与Ⅰ组和Ⅱ组比较,Ⅲ组术中出血量、红细胞悬液输入量和新鲜冰冻血浆输入量均减少,差异有统计学意义(P<0.05),Ⅲ组Plt与Hct在术毕和术后6 h两个时间点均高于Ⅰ组和Ⅱ组,差异有统计学意义(P<0.05)。Ⅲ组患者在术毕和术后6h两个时间点PT较短,差异有统计学意义(P<0.05),不同时间点APTT差异无统计学意义(P>0.05),术毕TT较短,差异有统计学意义(P<0.05),其余时间比较,差异无统计学意义(P>0.05)。结论氨甲环酸与注射用血凝酶复合使用较单独使用一种药物,可有效减少行全髋置换术的老年患者术中出血量、血制品需要量,可有效缓解围术期凝血功能失衡。
Objective To investigate the impacts of tranexamic acid combined with thrombin for injection on perioperative hemorrhage and coagulation function in elderly patients undergoing total hip arthroplasty.Methods A total of 90 patients with total hip arthroplasty treated in Baogang Hospital of Inner Mongolia aged from 60 to 80 years old from June 2018 to June 2019 were selected,and they were randomly divided into the groupⅠ(n=30),the groupⅡ(n=30)and the groupⅢ(n=30)according to the random number table method.For the groupⅠ(the group of tranexamic acid),tranexamic acid was diluted to 20 ml according to the standard of 15 mg/kg before operation,intravenous injection was performed immediately after skin incision,and the injection was added with the standard of 15 mg/(kg·h)during operation.For the groupⅡ(the group of thrombin for injection),thrombin for injection was diluted to 20 ml according to the label of 0.02 U/kg before operation,intravenous injection was performed 15 minutes before skin incision,and the injection was added with the standard of 0.01 U/(kg·h)during operation.For the groupⅢ(the group of tranexamic acid combined with thrombin for injection),they were diluted,administrated and maintained according to the standards of groupⅠand groupⅡ.Hematocrit(Hct),platelet count(Plt),prothrombin time(PT),activated partial thromboplastin time(APTT)and thrombin time(TT)were detected in three time points,which were before operation,after operation and 6 hours after operation.Results Compared with groupⅠand groupⅡ,the intraoperative hemorrhage volume,red blood cell suspension infusion and fresh frozen plasma infusion in groupⅢall decreased,with statistically significant differences(P<0.05),while Plt and Hct in groupⅢwere both higher than those in groupⅠand groupⅡin two time points,which were after operation and 6 hours after operation,with statistically significant differences(P<0.05).Pt of patients in groupⅢwasrelatively shorter in two time points,which were after operation and 6 hours after operation,with statistically significant differences(P<0.05).There was no significant difference in APTT in different time points(P>0.05).TT was shorter after operation,with statistically significant differences(P<0.05),and there was no significant difference in other time points(P>0.05).Conclusion Compared with the single use of one drug,the combined use of tranexamic acid and thrombin for injection can effectively reduce the intraoperative hemorrhage volume and blood product requirements of elderly patients undergoing total hip arthroplasty,and remarkably alleviate the imbalance of perioperative coagulation function.
作者
苏丽东
刘宇
郝春光
段霞光
朱海峰
黄再青
SU Lidong;LIU Yu;HAO Chunguang;DUAN Xiaguang;ZHU Haifeng;HUANG Zaiqing(Department of Anesthesiology,Baogang Hospital of Inner Mongolia,Inner Mongolia,Baotou 014010,China;Inner Mongolia Medical University,Inner Mongolia,Hohhot 010110,China)
出处
《中国医药科学》
2021年第16期9-12,16,共5页
China Medicine And Pharmacy
基金
内蒙古自治区包头市科技计划项目(2018C2007-3-4)。
关键词
氨甲环酸
注射用凝血酶
全髋关节置换术
凝血功能
Tranexamic acid
Thrombin for injection
Total hip arthroplast y
Coagulation function
