氨甲环酸对老年患者全膝关节置换围术期失血量及安全性影响的对照研究

目的探讨氨甲环酸对老年患者全膝关节置换围术期失血的影响及安全性。方法选择2012年6月--2013年7月行单侧全膝关节置换术的74例患者，男9例，女65例。年龄57—83（67．2±6．8）岁。其中骨性关节炎52例，类风湿性关节炎22例。采用随机数字表法随机分为两组，每组各37例。氨甲环酸组松止血带前30min将氨甲环酸1g稀释于250ml生理盐水后静脉点滴，对照组不给予氨甲环酸。比较两组术后引流量、总失血量及术后下肢深静脉血栓形成及肺栓塞的发生率。结果氨甲环酸组和对照组术后引流量分别为（572．3±38．7）ml和（769．6±34．5）ml，两组差异有统计学意义（P〈0．05）。氨甲环酸组和对照组手术总失血量分别为（691．8±88．7）ml和（968．5±38．2）m1，两组差异有统计学意义（P〈0．01）。术后两组无下肢深静脉血栓形成及肺栓塞发生。结论老年患者TKA围术期使用氨甲环酸能明显降低手术失血量，并且不增加静脉血栓及肺栓塞形成的风险。

Influence of tranexamic acid on blood loss in total knee arthroplasty and its safety

Objective To investigate the influence of tranexamic acid on blood loss during total knee arthroplasty （TKA） and its safety. Methods From June 2012 to July 2013 74 patients （9 males, 65 females）, aged 57 -83 （67.2 ± 6.8） years, under- went TKA for unilateral knee. All the patients included 52 ones with osteoarthritis and 22 ones with rheumatoid arthritis. They were divided into Group A and B at random （ n - 37 per group）. In Group A, tranexamic acid （ 1 g） dissolved in 250 ml of normal sa- line was intravenously infused 30 minutes before deflation of tourniquet; in Group B there was no tranexamic acid applied as an in- fluencing factor. The amount of drainage 48 hours after operation and the volume of gross blood loss 3 days after operation were re- corded. They were also observed for whether they had deep vein thrombosis 6 weeks after operation. Results There were sig- nificant differences in the amount of drainage （572.3 ± 38.7 vs 769.6 -± 34.5） after TKA and the volume of gross blood loss （691.8 ± 88.7 vs 968.5 ± 38.2） during TKA （P 〈 0.05, P 〈0. 01 ）. No deep vein thrombosis was found 6 weeks after operation. Conclusion The use of tranexamic acid can significantly decrease blood loss without increasing risk of venous thrombosis during TKA.