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术中应用氨甲环酸对全膝关节置换术后失血量的影响及安全性分析
引用本文:张楠,翁润民. 术中应用氨甲环酸对全膝关节置换术后失血量的影响及安全性分析[J]. 创伤外科杂志, 2017, 19(8). DOI: 10.3969/j.issn.1009-4237.2017.08.006
作者姓名:张楠  翁润民
作者单位:渭南市中心医院骨科一病区, 陕西,714000
摘    要:
目的探讨术中不同的氨甲环酸给药方法对全膝关节置换术后失血量的影响及安全性分析。方法选取2013年9月-2016年4月在渭南市中心医院骨科行全膝关节置换术的患者75例,按照随机数字表法将其分成3组,每组各25例。A组给予静脉输注氨甲环酸100mL,B组在关节囊缝合后向关节腔内注射氨甲环酸0.5g,C组静脉注射氨甲环酸80mL以及在关闭关节囊后关节腔内注射氨甲环酸20mL。观察比较3组术后72h内的血红蛋白含量、总出血量、显性出血量、输血情况、凝血功能指标以及体表瘀斑情况,并于术后7、14d通过下肢血管的多普勒超声比较患者是否出现下肢深静脉栓塞。结果 3组患者的术后血红蛋白含量较术前均显著降低(P0.05),A组和B组的血红蛋白含量比较差异无统计学意义(P0.05),C组患者在术后16h以及之后的血红蛋白含量显著高于A、B两组(P0.05)。C组患者的术后出血量在术后16h趋于稳定,显著低于A、B两组,且在显性失血量以及输血情况上优于A、B两组患者(P0.05)。3组患者术后3h的凝血指标差异无统计学意义(P0.05),C组患者术后体表瘀斑发生率显著低于A、B组患者(P0.05),且无患者出现下肢深静脉栓塞。结论关节腔内注射联合静脉注射氨甲环酸能明显减少全膝关节置换术患者的出血量且安全性较高,值得在临床推广应用。

关 键 词:关节置换  创伤性关节炎  氨甲环酸  膝关节  失血量

Effect and safety analysis of intraoperative application of tranexamic acid on blood loss after total knee arthroplasty
ZHANG Nan,WENG Run-min. Effect and safety analysis of intraoperative application of tranexamic acid on blood loss after total knee arthroplasty[J]. Journal of Traumatic Surgery, 2017, 19(8). DOI: 10.3969/j.issn.1009-4237.2017.08.006
Authors:ZHANG Nan  WENG Run-min
Abstract:
Objective To explore the effect and safety of applying acid tranexamic intraoperatively on blood loss after total knee arthroplasty. Methods Totally 75 patients who underwent total knee replacement surgery from Sep.2013 to Apr.2016 in our hospital were selected.They were divided into three groups with 25 cases in each group according to the stochastic method.Group A was given intravenous tranexamic acid for treatment, group B was given intra-articular injection of tranexamic acid after joint capsule suture, and group C was given treatment which combined intra-articular injection with intravenous tranexamic acid.Hemoglobin within 72 h after surgery, the amount of bleeding, the overt blood loss, blood transfusion, coagulation changes, skin surface bruising and deep vein thrombosis of patients were observed and compared. Results The postoperative hemoglobin of three groups decreased significantly compared with preoperative level (P<0.05).And there was no significant difference in hemoglobin of group A and group B (P> 0.05).The hemoglobin of group C after 16 h was significantly higher than group A and group B (P<0.05).Postoperative bleeding volume in group C after 16 h stabilized, significantly higher than group A and group B, and overt blood loss and blood transfusion of group C were better than group A and group B (P<0.05).There was no significant difference in postoperative coagulation at 3 h for three groups (P>0.05), and no patient with deep venous thrombosis was found.The rate of body surface petechiae patients in group C was significantly lower than group A and group B(P<0.05). Conclusion Intra-articular injection combined with intravenous tranexamic acid can significantly reduce the amount of bleeding in total knee replacement surgery patients and have high security,which is worthy of promotion.
Keywords:arthroplasty  traumatic arthritis  tranexamic acid  knee joint  blood loss
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