重复使用氨甲环酸对TKA术后失血量及安全性的影响

目的探讨重复使用氨甲环酸(tranexamic acid,TXA)对初次单侧全膝关节置换术(total knee arthroplasty,TKA)后失血量及安全性的影响。方法选择2015年1月—2016年5月霸州市第二医院行TKA手术的创伤性关节炎患者138例,随机数字表法分为对照1组、对照2组与观察组,每组46例。对照1组在术前静脉滴注TXA 15mg/kg;对照2组在松止血带之前静脉滴注TXA 15mg/kg;观察组松止血带前静脉滴注TXA 15 mg/kg,30min内输注完。术后3h再次按该剂量静脉滴注。观察和比较三组总失血量、术后引流量、隐性失血量、术后血红蛋白(Hb)水平、输血率以及术后深静脉血栓和肺栓塞发生率。结果观察组总失血量(715.0±197.6)mL、术后引流量(117.53±46.35)mL明显少于对照1组(823.2±186.5)mL、(230.61±43.09)mL和对照2组(926.7±206.3)mL、(310.98±73.09)mL,术后Hb水平(113.7±14.6)g/L高于对照1组(94.9±13.9)g/L和对照2组(92.6±11.3)g/L,差异有统计学意义(P0.05),对照1组总失血量、术后引流量小于对照2组,差异有统计学意义(P0.05)。3组异体输血率和术后血管栓塞发生率无明显差异。结论与术前和松止血带之前单剂量使用TXA相比,TXA术后重复使用能有效减少失血量,且不增加血管栓塞的发生风险。

Influence of repeated use of tranexamic acid on blood loss and security in patients with primary unilateral total knee arthroplasty

Objective To explore the effect of repeated use of tranexamic acid on blood loss and security in patients with primary unilateral total knee arthroplasty(TKA).Methods Totally 138 patients with traumatic arthritis who received TKA in the Second Hospital of Bazhou City from Jan.2015 to May 2016 were enrolled in this study,and were assigned randomly to control 1 group,control 2 group and the observation group according to the number list method,with 46 cases in each group.The patients received 15 mg /kg TXA by intravenous infusion before operation in control 1 group,received 15 mg/kg TXA by intravenous infusion before tourniquet release in control 2 group,received 15 mg/kg TXA before tourniquet release and at 3h after operation respectively in the observation group.Total blood loss,postoperative blood loss via drainage,hidden blood loss,postoperative Hb level,allogeneic blood transfusion rate,incidence of postoperative deep vein thrombosis and pulmonary embolism were observed and compared in three groups.Results The total blood loss ((715.0±197.6)mL) and postoperative blood loss via drainage ((117.53±46.35)mL)in the observation group were less than those in control 1 group((823.2±186.5)mL,(230.61±43.09)mL) and in control 2 group((926.7±206.3)mL,(310.98±73.09)mL),while the postoperative Hb level ((113.7±14.6)g/L) was higher than that in control 1 group((94.9±13.9)g/L) and in control 2 group((92.6±11.3)g/L),and the differences were statistically significant(P＜0.05).The total blood loss and postoperative blood loss via drainage in control 1 group were less than those in control 2 group,and the differences were statistically significant(P＜0.05).The difference of rates of allogeneic blood transfusion and postoperative vascular embolization was not statistically significant(P＞0.05).Conclusion Compared with application of a single dose of 15 mg /kg TXA before operation and tourniquet release,postoperatively repeated use of TXA can effectively reduce the blood loss,and does not increase the risk of vascular embolization.