氨甲环酸对全膝关节置换术围手术期失血量的影响及安全性评估

目的 探讨氨甲环酸对全膝关节置换术围手术期失血量的影响及安全性.方法 2008年5月至2009年2月,选取98例拟行全膝关节置换术的患者.男35例,女63例.病因:骨性关节炎66例,类风湿关节炎32例.病程2～12年,平均5年.随机分为A、B两组,每组49例:A组在松止血带时将氨甲环酸1 g稀释于250ml生理盐水后静脉点滴,3 h后以相同剂量再次给药;B组仅给予等量生理盐水静脉点滴.以术中失血量、术后可见失血量、输血量、输血人数、术后血红蛋白和术后纤维蛋白原、凝血酶原时间等为评价指标,对两组进行比较.观察患者术后是否出现下肢深静脉栓塞的临床症状,并于术后14d进行下肢血管多普勒检查.结果术中失血量两组比较差异无统计学意义(P>0.05),但术后可见失血量、输血量、输血人数A组均明显少于B组(P<0.05).术后血红蛋白值,A组明显大于B组(P<0.05).两组患者术中松止血带和术后3 h纤维蛋白原、凝血酶原时间和活化部分凝血活酶时间的比较差异无统计学意义(P>0.05).术后14d未发现卜肢深静脉血栓形成.结论 在全膝关节置换术中及术后短期使用氨甲环酸能明显降低患者失血量及输血量,并且不增加静脉血栓形成的风险.

Efficacy and safety of tranexamic acid on perioperative blood loss in total knee arthroplasty

Objective To investigate the efficacy and safety of tranexamic aeid on perioperative blood loss associated with total knee arthroplasty(TKA). Methods From May 2008 to February 2009, 98 pa-tients (35 males, 63 females) underwent TKA, 66 cases with osteoarthritis, 32 with rheumatoid arthritis. The course of illness ranged from 2 to 12 years (mean, 5 years). They were randomly divided into Group A and B with 49 patients each. The patients in Group A received tranexamic acid, and the patients in Group B re-ceived an equal volume of normal saline, in Group A, 1 g of tranexamic acid dissolved in 250 ml of normal saline was intravenously infused before deflation of the tourniquet; another intravenous administration of the same drug of the same dosage was given 3 h later. In Group B, only 250 ml of normal saline was infused in-travenously. The amounts of intraoperative blood loss, postoperative wound blood loss and blood transfusion,the number of the patients needing blood transfusion and the value of postoperative hemoglobin concentration of all patients were recorded. Fibrinogen, prothrombin time, and activated partial thromboplastin time were also examined before operation, during operation (deflation of the tourniquet), and 3 hours after operation.And they were also observed for whether they had deep vein thrombosis and both lower limbs of all patients were examined by the color Doppler uhrasonography 14 days after operation. Results There was no signifi-cant difference in intraoperative blood loss botween two groups(P >0.05). There were significant differences in the amount of postoperative wound blood loss, blood transfusion, the number of the patients needing blood transfusion and the value of postoperative hemoglobin concentration between two groups, Group A were lower than Group B (P< 0.05). The postoperative hemoglobin concentration was higher in Group A than that in Group B (P< 0.05). There were no significant differences in the levels of fibrinogen, prothrumbin time, and activated partial thromboplastin time between two groups (P>0.05). And no deep vein thrombosis was found 14 days after operation. Conclusion During and after the TKA, a short-term use of tranexamic acid can significantly decrease blood loss and blood transfusion without increasing risk for venous thrombosis.