氨甲环酸不同给药时间对减少全髋关节置换术失血的影响

目的探讨氨甲环酸(TXA)在不同的给药时间对减少全髋关节置换术(THA)失血的有效性。方法前瞻性分析2014年1月—2017年12月安徽医科大学第一附属医院行单侧THA患者90例,男性26例,女性64例;年龄18~80岁,平均67.9岁。采用随机数字表法分为A、B、C三组,各30例。采用双盲法(患者及主刀医师对所在组别并不知晓)分别于术前15min(A组),术后15min(B组)和皮肤缝合结束时(C组)静脉注射TXA 30mg/kg。比较三组患者术中及术后失血量、输血次数、Hb下降量及下肢深静脉血栓(DVT)发生率。结果与B、C组相比,A组术中A vs.B vs.C,(133.9±47.6)mL vs.(203.0±58.9)mL vs.(212.6±56.7)mL,F=18.520,P=0.001及术后失血量A vs.B vs.C,(721.0±86.2)mL vs.(735.6±63.2)mL vs.(791.6±92.7)mL,F=6.251,P=0.003减少,Hb下降程度A vs.B vs.C,(22.0±6.0)g/L vs.(28.2±7.0)g/L vs.(29.4±9.5)g/L,F=8.138,P=0.001更小,术后输血次数较C组减少(A vs.C,2 vs.9,χ2=7.274,P=0.026)。三组患者术后DVT发生率差异无统计学意义。结论术前15min静脉注射TXA,可以更有效地减少术中及术后出血,有助于维持术后Hb含量,降低输血率。

Efficacy comparison of tranexamic acid for reducing blood loss in total kneearthroplasty at different administration time

Objective To compare the efficacy of intravenous administration of tranexamic acid(TXA)for reducing blood loss in total knee arthroplasty(THA)at different administration time.Methods From Jan.2014 to Dec.2017,90 patients with unilateral THA who underwent unilateral THA in the Department of Orthopaedics at the First Affiliated Hospital of Anhui Medical University were recorded in this prospective study.There were 26 males and 64 females,18 to 80 years old,with an average of 67.9 years old.They were randomly divided into three groups,A,B,and C,with 30 cases in each group.Double-blind method(both the patient and the doctor did not know which group he was in)was used to inject TXA 30mg/kg 15 minutes before the operation(group A),15 minutes after the operation(group B)and at the end of skin suture(group C).The intraoperative and postoperative blood loss,the times of transfusion,the decrease in Hb,and the incidence of deep vein thrombosis in the lower extremities were compared.Results Compared with groups B and C,the intraoperative blood lossA vs.B vs.C,(133.9±47.6)mL,(203.0±58.9)mL,(212.6±56.7)mL,F=18.520,P=0.001]and postoperative blood lossA vs.B vs.C,(721.0±86.2)mL,(735.6±63.2)mL,(791.6±92.7)mL,F=6.251,P=0.003]in group A reduced,the degree of Hb declineA vs.B vs.C,(22.0±6.0)g/L,(28.2±7.0)g/L,(29.4±9.5)g/L,F=8.138,P=0.001]in group B was lower,and the times of postoperative blood transfusion was reduced compared with group C(A vs.C,2 vs.9,χ2=7.274,P=0.026).There was no significant difference in the incidence of deep vein thrombosis(DVT)among the three groups.Conclusion Intravenous TXA 15mins before surgery can effectively reduce intraoperative and postoperative bleeding,help maintain Hb content after operation,and reduce the rate of blood transfusion.