摘要
目的探讨静脉多次应用氨甲环酸减少初次全膝关节置换术围手术期失血量的临床效果。方法纳入自2018-01—2018-12完成的150例初次单侧全膝关节置换术,A组50例在止血带充气前20 min静脉应用氨甲环酸(30 mg/kg);B组50例在止血带充气前20 min给药(20 mg/kg),3 h后再次给药(10 mg/kg);C组50例在止血带充气前20 min给药(10 mg/kg),3 h后第2次给药(10 mg/kg),6 h后第3次给药(10 mg/kg)。比较3组术后第2天血红蛋白下降值、纤维蛋白原、D-二聚体、凝血酶原时间、活化部分凝血酶原时间,术后肌间静脉血栓发生率,以及总失血量、术中失血量、术后失血量。结果 150例均随访4周后进行结果评定,所有患者恢复良好。术后3组各有2例需要输血。C组总失血量、术后失血量小于A组和B组,C组术后第2天血红蛋白下降值低于A组和B组,C组术中失血量大于A组,差异有统计学意义(P<0.05)。3组术后肌间静脉血栓发生率差异无统计学意义,术后第2天纤维蛋白原、D-二聚体、凝血酶原时间、活化部分凝血酶原时间差异无统计学意义(P>0.05)。结论氨甲环酸能有效减少初次全膝关节置换术患者围手术期失血量并降低输血率,总剂量相同的氨甲环酸静脉多次应用较单次应用更有效,不会增加血栓发生的风险。
Objective To explore the clinical efficacy of multiple intravenous application of tranexamic acid(TXA) in reducingperioperative blood loss in primary total knee arthroplasty(TKA).Methods A total of 150 patients who underwent primary uni-lateral TKA from January 2018 to December 2018 were included. In group A, 30 mg/kg TXA was intravenously given 20 min-utes before tourniquet inflation in 50 patients. In group B, 50 patients received 20 mg/kg TXA 20 minutes before tourniquet in-flation and 10 mg/kg TXA again 3 hours later. In group C, TXA was given at a dose of 10 mg/kg 20 minutes before tourniquet in-flation, the second dose of 10 mg/kg was given 3 hours later, and the third dose of 10 mg/kg was given 6 hours later. Total bloodloss, intraoperative blood loss, postoperative blood loss, the incidence of deep vein thrombosis, hemoglobin drop, fibrinogen,prothrombin time, activated partial thromboplastin time on the second postoperatively day were compared in 3 groups.Results One hundred and fifty cases were followed up for 4 weeks, all patients recovered well. Two patients required blood trans-fusion in each of the 3 groups postoperatively. Total blood loss, postoperative blood loss, and hemoglobin drop on the secondpostoperatively day in group C were lower than those in the groups B and C, there were significant statistical differences(P<0.05). The intraoperative blood loss in group A was lower than that in group C, there was significant statistical difference(P<0.05). There were no significant differences in the incidence of venous thrombosis, and fibrinogen, prothrombin time, activatedpartial thromboplastin time on the second day postoperatively between 3 groups(P>0.05).Conclusion TXA effectively reduc-es perioperative blood loss, and transfusion rate in primary TKA. With same total dose, multiple dose intravenous application ofTXA is more effective than single dose intravenous application, without increasing of the risk of embolic events.
作者
潘文杰
贺艳
马建兵
肖琳
PAN Wen-jie;HE Yan;MA Jian-bing;XIAO Lin(Department of Bone and Joint Surgery,Xi'an Honghui Hospital,Xi'an Jiaotong University,Xi'an,Shaanxi 710054,China;不详)
出处
《中国骨与关节损伤杂志》
2021年第12期1254-1257,共4页
Chinese Journal of Bone and Joint Injury
基金
陕西省自然科学基金面上项目(2017JM8167)。
关键词
全膝关节成形术
氨甲环酸
静脉滴注
多次应用
失血量
Total knee arthroplasty
Tranexamic acid
Intravenous drip
Multiple application
Blood loss
